HomeMy WebLinkAboutX2022-0541 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application 01%
r Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rXBuilding r'• Grading rDrainage r Elec rMech
r Plum Cu Yd Cut Cu Yd Fill F_
Project Address (Not mailing address) r Flood
r Fire r Liq 10 Landslide rN/A Floor Suite No
Description of Work
Use F—Const Type V
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Stories # Units (if Res)F_
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New/Add SF Remodel SF Garage/New/Add
Valuation $
Material/Labor®I®f�
OWNER'S NAME Last
First Rie s S 0dVj)R0
Owner's Address
Owner's E-mail Address
City jA.Q� pek- (,p }- State I� '
Zip IKUS l TelephonaF
APPLICANT'S NAME Last GT0,f-
First
Applicant's Address
Applicant's E-mail Address
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PX\�@YY��o11toZZiwrck�i�tcshnrt. con/1
City WI�A State I V'� —
Zip 1l�10�� Teelephone 53�)jDOU -$D)4
ARCHITECT/DESIGNER'S NAME Last PA\o,\ ouk FFirst Ul ,(\q Lic. No. �35S�S
Architect/Desi gners Address
Architect/Designers E-mail Address
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��or9�t@Mtg\:ozzio�LTNh� 2clure_Csont
City v,&M State ft
Zip qM't) Telephone G,10)1, (-1_. JZJJ
ENGINEER'S NAME Last
First 1.�'I `_) Lic. No. \q,_p5A
Engineer's Address
Engineer's E-mail Address
ti'I'IS�a Sa�ntu.Mor�a,rrra�� #r2$�
City i�lS&\bn X�p State 16" —
Zip g2toq I Telephone cjjq)�loo-9"IOZ
CONTRACTOR'S NAME/COMPANY
Lic No. ��pu`}'j'� Class
Contractor's Address
Contractor's E-mail Address
[b�� i^(i� <()V (Ue1c4
pLCc� S�(vC�'on61 1
City I Cp��f:2 MLSI.z State (l
Zip `�,t Ll- Telephone c ,,,3,
S BA S REAR SETBACKS FRONT
PERMIT NO. n7.oZ2 —0541
SE CK LEFT SETBACKS RIGHT
9
PLAN CHECK NO, W sp �tan-
U Z DEVELOPMENT NO
PLAN CHECK FEES $ 1141 Al