HomeMy WebLinkAboutX2021-2889 - Permit Application (3)Print Form Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division
j Comm'I J)(Residentia, NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
.RBuilding r Grading rDrainage r Elec r Mech 151� Plum C. Yd Cut Cu Yd Fill
Project Address (Not mailing address) I— Flood 16 Firer Liq F_ Landslide I —N/A Floor Suite No "
rj' SdK Piet, (64 Well" Gyy 0/u h T-, X4vr F I
Description of Work
C04VI/xr
rr-, -94, le -
Remodel
SF 1�0 Garage/New/Add
New/Add SFr— I —
OWNER'S NAME Last 81-rdva FAJ✓ First i3T-
Owner's Address
S 5a� Mrrr1 k tad
City State
APPLICANT'S NAME Last I Li
Use r_ ConstType r
# Storiesr— # Units (if Res)F
Valuation $ -o
Material/Labo
Owner's E-mail Address
Zip F9 2 Gz f
First
3749)396 0799
Applicants Address p Applicant's E-mail Address n
h J2�1Gl.^O/�/'��1kael•X. CrD f�l
City L¢yc'/e t-sY�j� State I Zip 92G3o Telephone 999, y29-- 1357
ARCHITECT/DESIGNER'S NAME Last �R2 wt
First Fed 4 i µ Lic. No. 5 s 1 1-1D
Architect/Designer's Address Architect/Designer's E-mail Address
613 2 5 �¢ cltrw� K g ln/C uca:Q • C� ,
city (p-✓ f N f State ( Zip i Z 6 f y Telephone 7!4) 2 4 Y i77$
ENGINEER'S NAME Last
First
Lic.
Engineers Address (j. Ivv Engineer's E-mail Address
City State I.-- Zip r---- Telephone
�—
Lic No. F— Class
CONTRACTOR'S NAME/COMPANY
Contractors Address Contractor's E-mail Address
State �— Zip-- Telephoner---
City ..••��
SETBACKS REAR
SETBACKS FRONT PERMIT NO. X �' ;Lft9
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. 2po✓q'2 CLI-0
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $