HomeMy WebLinkAboutX2022-1195 - Permit Applicationprint Fora, W flrs�eet for Combo Building & Solar Permit Application 4%11§11ra
r, Comm'I f4 Residential
�\
x miry or Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL c ,
(_ Building Grading rainage [ (Elec Mech Plum curdCut F cuYdFill G� `
Project Address (Not mailing address) r Flood r Fire _ Liq (— Landslide FN/A Floor Suite No
Description of Work Use (� . Const T e
yP
i # StoriesFT # Units (if Res)
New/Add SF 3L)Sc Remodel SF O Garage/New/Add e/New/Add Valuation $
9 pMaterial/Labor I, O v� Poo
OWNER'S NAME Last First n M
__S]11S.1T71d1.n`1nCk:inS�. ..__......_!.�_{_1_C✓tn—t��=`�.___Y--'a��(�`�,�D1� __ _ _..
Owner's Address J Owner's E-mail Address
fC �c�11 ��
City tCg-fn '�OL�S2- - l^1
State
I �av i �/ f tG .tom �� Zip 1 .. l- _. Telephone
APPLICANT'S NAME Last First rst
1-6c YYIo JC,I
Applicant's Address
Applicant's E-mail Address
r,
�LchL,nv_�ru�-GOB
City . �\ State }� Zip
' w t �l • .._ / L Telephon 3.�Qe �0� 13 °}�
ARCHITECT/DESIGNER'S NAME Last
("e C4 First w) Lic. No.
a
I
Architect/Designer's Address Architect/Designers E-mail Address
City
O(i S State �( Zip J_� C . Telephone
ZD \ 91
3
ENGINEER'S NAME Last "C b r_i A First A�A, Lic. No.FaTc j
Engineer's Address Engineer's E-mail Address
LIq-� C A))``h S f fx _ \
City
Zip
CV S �C\ State �— Clad Telephone
l 9�C1 oW
CONTRACTOR'S NAME/COMPANY Lic No. F— Class
O _ - __ _
Contractor's Address Contractors E-mail Address
City State F— Zip �— Telephone—
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $