HomeMy WebLinkAboutX2021-3198 - Permit ApplicationPrint Form' _Worksheet for Combo Building & Solar Permit Application o�EWaoRe
F_ Comm'I F_ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL U
F_Building F_ Grading F-Drainage F_ Elec i- Mech F_ Plum CuvdCut F CuYdFill F
Project Address (Not mailing address) F_ Flood (- Fire [_ Uq r Landslide F_N/A Floor Suite No
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Description of Work
Use Const Type
QQM^a i5i 1 S\ [ FAiy\.t_-t
# Stories #Units (if Res)
6 pnai,C
Valuation $
Material/Labor
New/Add SF F Remodel SF� Garage/New/Add �
OWNER'S NAME Last I AfLD" D.'cC PIV 5 First
Owner's Address Owner's E-mail Address
City State l ( ' Zip C1'L66Z TelephoneF
APPLICANT'S NAME Last V I TA(LeI.L , First cy_� ✓\ $
Applicant's Address Applicant's E-mail Address
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,40 3V t�AL fi \br
A'ZELLI 6 iKA-,tt_.Q
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City S,�A �n State Zip q'L UbZ Telephone
ARCHITECT/DESIGNER'S NAME Last JVL \SUS/ First T __/ Lic. No. �—
Architect/Designer's Address Architect/Designees E-mail Address
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City I }jZ wpv—z GeAc_vl State �r�. ZiP o(w() C Telephone Frt - 7 Z-s -tog(
ENGINEER'S NAME Last First J\L t Lic.No.7—
Engineer's Address Engineer's E-mail Address
l T 1 S\L �) P,a2v-_ G RGR
City ::74 \/\^re C^1 State Zip �z4t Telephone q4 9 - y66 _93q y
CONTRACTOR'S NAME/COMPANY J tvC Lic. No. q 5-N(� Class 8
Contractor's Address Contractors E-mail Address
NO O co VtT o2et_,4 ( 6_GNA LL Co
City 6AL � (SLA r-/o State �— Zip �5L&b� Telephone qt-(c/- 6%5 -(� 7Z
SETBACKS REAR SETBACKS FRONT PERMIT NO. X Z 02 - 3/
SETBACKS LEFT SETBACKS RIGHT CHECK NO.
USE ZONE DEVELOPMENT NO J)ZJJVP��ZCHECK FEES $
111