HomeMy WebLinkAboutX2022-0270 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
[ Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
�-B uilding r Grading [Drainage [i Elec
Address
21v0 vc��l
Mech [ Plum
F7 Flood [ Fire [ Liq
Cu Yd CutF- Cu Yd Fill
f -. Landslide [N/A III���
Floor Suite No
Description of Work Use IT- ConstType NF7
If 4Tc;-nloyz. tL_--W Pbm� tZZL IZZM
IF Stories#Units (if Res)
L
Valuation $
New/Add SF 5- Remodel SF[Ei�jf-- Garage/New/Add Material/Labor e
OWNER'S NAME . Last
Owner's Address
city state G
APPLICANT'S NAME Last
Applicant's Address
F, 0 - 1;0 ' I s------
city P776_y_& State G�
ARCHITECT/DESIGNER'S NAME Last
First
Owner's E-mail Address
17�.s�5L�-lS�-� L lMblc� C�vt„�
Zip
First) L2,27ra
t
Applicant's E-mail Address
Zip171 2 ���, Telephone q C 6SD �/ �'- &
First ', Lic. No. cZ4) L0>4
ArchitecNDesigners Address �a M `� Architect/Designees E-mail Address
City State 1777 Zip C Telephoned t
ENGINEER'S NAME Last First ) 3 � T__t Lic. No. S �o �
Engineers Address
City State G�S
Enginee-r(s E-mail Ad}d�ress n
Zip j TelephoneW -Zrc� JAI 4(21'
CONTRACTOR'S NAME/COMPANY Lic. No. FIL Class
Contractor's Address
�C /t6 S LA Pwyw. A S1rL
City % r A Lr , "_ State [°A
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
Contractors E-mail Address fO t 3 6 0 i IZ V 1i RL
CU L n._4 Ji jde-5 6rS3C: Qo6A1 :hkA—
Zip Telephone 7 H bEiz--45`1SI
PERMIT NO.
PLAN CHECK NO. Z
PLAN CHECK FEES $ 5
z i �� .