HomeMy WebLinkAboutX2021-3431 - Permit Application_Priht Fc m Worksheet for Combo Building & Solar Permit Application
F Comm'I City of Newport Beach - Building Division
j(Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
j�Building Grading Drainage �Elec �Mech Plum cuvdcut� curdFill
Address
Flood Fire f- Liq F- Landslide rN/A Floor
(Not mailing address) � � r--
;:C . I Iz W , Fr ,+ �
of Work
Suite No
Use F- ConstType V '
INTEVIktL (L1It4CeI L ITII f" �� G XtSw Ce7C3 i7� ��^ #Stories 3 # Units (if Res)j
�iX(111E j AIvO 191)hi 14klc I l;Lul Ec a c �IR� (TfKc u 1 a ,v t1wfJ iJttL)
Rc at�rt. _ XlS rW' 6XlSl`/uv R 71[u r/_F U. 1 YA40+
1 di iw �� � Valuation $ yy^ C<-
New/Add SFRemodel Remodel SF_ Garage/New/Add �— Material/Labor C i
OWNER'S NAME Last WaJj Firstl�(�/ ----
Owner's Address
City � �; At IJw't+ State FC44
APPLICANT'S NAME Last Ftilt-ey
Applicant's Address
131Y3 LIB ce4lk aA TL # 101
- - -
Citv tJ&4C.'�i,„A Iku, t State Gf}
ARCHITECT/DESIGNER'S NAME Last 1041Ley
Architectinesigner's Address
51>> ��� i ,{ Cl3ch? k fXL 1* IG
City .J9 L. SState
ENGINEER'SNAME Last
Engineer's Address
City State
CC) NTR gCTgR'S NAME/COMPANY
Contractor's Address
City State
sE_-gACKSREAR SETBACKS FRONT
SE -?BACKS LEFT SETBACKS RIGHT
U E7—. ; _ DEVELOPMENT NO
Owner's E-mail Address
Zip cfuP(D✓7 Telephone (�(4� .._✓�� 7-WI
First 5 1)Ib _
Applicant's E-mail Address
:1
Zip `� Z(v_S Telephone q�-i"l - S 7 OL
First Lic. No. C 27�iC
I
ArchitecUDesigner's E-mail Address
— V)No C� pCi y2Cit_CCIi/f
Zip iZ(v S� Telephone
First
Engineer's E-mail Address
Lic. No.
l
Zip TelephoneF—
Class
Lic. No.
Contractor's E-mail Address
147eZI-01
Zip F� Telephone
ELL",I -f ),-
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEES $