HomeMy WebLinkAboutX2021-0228 - Permit ApplicationPrint Form
Comm'I F
Worksheet for Combo Building & Solar Permit Application
Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL ?<lb it -C"
Building F Grading F-Drainage F_ Elec r Mech
r- Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) F_ Flood
F_ Fire j— Liq r Landslide I —N/A Floor Suite No
1 GO t�,,NkAif cv-vow:
Description of Work
Use l l _ Const Type 4
gNNp�1 to" t kt STI nILq Cv VESj1k>W6 ANo cePPAvs
# Storiesk t7 # Units (if Res) ISL
Valuation $
Material/Labor 3t 6zS) Dr6
New/Add SO %� -- Remodel SF SZ1 513 Garage/New/Add
OWNER'S NAME Last �Ap�j�
First (Z(Ir1
NZw1'orC7 F�o'Y_L, LA
Owner's Address
Owner's E-mail Address
City r/��`'t� 6c 't74c* State 4�
Zip qzi( Telephone Tf 9 8,-46 (2-7-7
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
-(.30 .SET uro&VAP ISL-V.P
��W °� vSTa+uTi R.GOIti
City -" CW,941N 19, State C14
Zip ;Sp,$ Telephone ilc, 'ISD-a LZ�
ARCHITECT/DESIGNER'S NAME Last `t �l✓� First 1 4q
i $S�V Lic No. II
Architect/Designer's Address
Architect/Designer's E-mail Address
2�3o SEPuC I�vP �cV(D
(=-QSS1V4z-T yv ��vST�.1 T tNE2-co^^
City 6y(ACA-AC.L State r�—
Zip RvSzs Telephone OSD
ENGINEER'S NAME Last I
First F_ Lic. Nof—
Engineer's Address
Engineer's E-mail Address
City I State F_
Zip F_ Telephoned
CONTRACTOR'S NAME/COMPANY
Lic. No. F—Class
Contractor's Address
Contractor's E-mail Address
City State Fi
Zip F Telephoned
SETBACKS REAR SETBACKS FRONT
PERMIT NO. �! Z �) — (,� ��-- Z l �'
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. /'-)i _6 C
USE ZONE DEVELOPMENT NO D �C'' t�J, -c , L 5 PLAN CHECK FEES $