HomeMy WebLinkAboutX2021-0660 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application o ` °"�
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j- Comm'I Residential City of Newport Beach - Building Division l 5
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL �( W- o1ptS(o
Building Grading XDrainage F Elec V, Mech
W Plum Cu Yd cut Cu Yd Fill F
Project Address (Not mailing address) F_ Flood
F_ Fire F_ Liq F_ Landslide F_N/A Floor Suite No
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Description of Work
Use t" e ConstType ✓ rj
# Stories # Units (if Res)[
ryr� oP re) 2 5To,Py sF,e- ANp � d�T/OAl
Oj NEW 2 STaLI� St,�
Valuation $
New/Add SF Remodel SF Garage/New/Add
/ �0
Material/Labor [,/��
OWNER'S NAME Last {-,�i"r-p
First G}.//Q/S HND J/GL
Owner's Address
Owner's E-mail Address
l9 )P,41/1V7 nG�aMA
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city C-141M DEG State
Zip 726Z S Telephone s4o/`0-25,7g0
APPLICANT'S NAME Last 0/is&
First r-- / C
Applicant's Address
Applicant's E-mail Address
���.�'f��F���• 2728 � Go�S'T N� �A
er i c � Pa-'ic o�s�es In • Gv �
city FM State I —' " Zip q Zb Zs Telephone q4%- 88 7.88"; G
ARCHITECT/DESIGNER'S NAME Last S M First Lic. No. ^38 /
Architect/Designees Address
Architect/Designees E-mail Address
City State F
Zip �— Telephoned
4F_
ENGINEER'SNAME Last f ���
First����'Z Lic. No.
Engineer's Address
Engineer's E-mail Address
s`f, vN/r
�1aleC es rime .��,
city FS'AA7A 61 ,+ State ejA
Telephone
Zip !I Z 70J
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CONTRACTOR'S NAME/COMPANY Le
/ a���
r Lic. No Clas�
Contractor's Address
Contractor's E-mail Address
City State F_
Zip F TelephoneF—
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. D(ood - Zo21
USE ZONE DEVELOPMENT NO
0Ai PLAN CHECK FEES $