HomeMy WebLinkAboutF2022-0400 - Permit ApplicationPrint Forth Worksheet for Combo Building & Solar Permit Application
I Comm'I City of Newport Beach - Building Division Residential g
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTALL
Building ❑Grading ❑Drainage AElec r/rMech F lPlum Cuydcuf-7-j CUYdFill
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Projec/t• /Address (Not mailing address) Ell Flood ❑ Fire ❑ Liq [ Landslide r i/A Floor Suite No
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Description of Work b
-- f Use (oType
nst
F/
q Stories # Units (if Res) ,,
Valuation
New/Add SF� Remodel SF j � Garage/New/Add—� Material/tabor Z�L��,
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OWNER'S NAME Last — --
First
Owner'sAddressOwners E-mail Address
City _�/A/� I State Zip Telephone
APPLICANT'S NAME Last ! First
Applicant's Address Applicant's E-mail Address
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City Oh�G�- � State C� I Zip q Z� (j7i Telephone 2•
ARCHITECT/DESIGNER'S NAME Last First
Architect/Designees Address
City J�G� ��k State (I
Lic No_ G.h
Architect/Designees E-mail Address t
ZIP r 66 J Telephone q q e14 �4
ENGINEER'S NAME LastC_ _ First F Lic No.�
Engineers Address
I
City State
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Engineers E-mail Address
Zip Telephone
CONTRACTOR'S NAME/COMPANY I'llf I Lic. No. %2 y01 I Class /�
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c nu dig/IlC�2�csi Inc
Contractors Address
City State —l---'
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
Contractors E-mail Address
Zip -11'1 C i S Telephone C/ z- `/ %51 9050
PERMITNO. 4C.7e5lJZ — (� - l
PLAN CHECK NO. PCT-L L - ti Ze
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
Worksheet for Fire Permit Application *�wl_-
zhCity of Newport Beach - Building Division -071�,� ��
Please print 3 copies
Associated Building Permit # _ ❑ Fire Sprinkler I Fire Alarm ❑ Fire Misc
1. Project Address (Not mailing address) Floor Suite No
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Tenant Name # Units
2. Description of Work J t((
f Af,& l 1 — -� Use _ d
1-- �---; Valuation $ Ma
Extg Sq Ft New/Added Sq Ft Total Sq Ft
# Stories
❑ New ❑ Add ❑ Alter ❑ Demo L_
Check Appropriate Box for Applicant/Notification
❑ 3. Owners Name -
Last rst��
Owner's Address
Owner's E-mail Address
City
State `�� Zip 11I ? (% Telephone) "►,y'�l /IV- -141j
—! _ —_� -
4. Architect/Designer's Name Last First Li�c. No. �!
Architect/Designer's Address
Architect/Designees E-mail Address
City
State Zip — Telephone-
❑ 5. Engineer's Name
Last d}Z ! First tG.. LicNo.LLLLLL
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Engineer's Address
Engineer's E-mail Address
city
State Zip Telephone qd - �D T I bw
❑S. Contractor's Name Last
1S �r��laacll &i �K,'Zl c, .t Lic. No. j6.�2 ypj ' Class��
-r -- — - --- - -. I— _,
—I.
Contractor's Address
Contractor's E-mail Address
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City 72,v1i7e
_-_� State—.J Zip �26�5, Telephone �/
OFFICE USE ONLY
PERMIT NO. (Z Lf CO
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY- GROUP
PLAN CHECK FEE $