HomeMy WebLinkAboutX2021-0885 - Permit ApplicationPrint Form 1 Worksheet for Combo Building & Solar Permit Application
F_ Comm'I r Residential City of Newport Beach - Building Division
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F_ Building F_ Grading rDrainage Elec Mech um CuvdCut� CuVdFill
Project Address (Not mailing adlldress) f Flood F_ Fire F_ Liq F_ Landslide F_N/A Floor Suite No
�i 10aN L4NE— (�-� F
Description of Work
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Use �F� ConstTyp
f iO�S.� 1� ING�-Er4S� SF�✓. �M � �'�'1��G l?�it1�
# Stories #Units (if Res)
wrr-i3o-/ N� P*N�y f F/t✓)it f. )�o,�
Valuation
Material/Laa bor
New/Add SF 165 Remodel SF 3 �.}� '} Garage/New/Add �
OWNER'S NAME Last �C FF Ly� First Scv7r
Owner's Address Owner's E-mail Address
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City E(V0 ,P %=�.i�/ % State r Zip�Q Telephone
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APPLICANT'S NAME Last First
Applicant's Address Applicant's 12-mail Address
City F State � Zip F Telephone
ARCHITECT/DESIGNER'S NAME Last OF A•nl First �QN Lic. No. C S(O 7
Architect/Designees Address Architect/Designees E-mail Address
455-� E,Nol(dP7
city W�j"/A 1 State f�� Zip ga�v5 Telephone �/ �7�3
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ENGINEER'S NAME Last
Last B TS' FirstPd (! Lic. No.
Engineer's Address Engineer's E-mail Address
@WAI
City S/¢/V74nf4 State O-4 Zip 9 Telephone 65 — / 1 / /
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CONTRACTOR'S NAME/COMPANY Lic. No. ��� ��_ Y Class
S � Aw O �h� D�� . �u�
Contracctor's Address Contrractt6r's E-mail Address
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State CO ZipWi6b_�Telephone c y �• Zl
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S BACKS REAR (9 SETBACKS FRONT % PERMIT NO.
SETBACKS LEFT 6' SETBACKS RIGHT (7' PLAN CHECK NO.
USE ZONE 12 ' ' &Vda DEVELOPMENT NO PLAN CHECK FEES $ 0I . t�
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