HomeMy WebLinkAboutX2021-0504 - Permit Application (3)Print Form j Worksheet for Combo Building & Solar Permit Application
(-, Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
[_Building I— Grading F-Drainage
Mech Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) r Flood r- Fire r Liq [ Landslide (-N/A Floor Suite No
2-7 1 Q9 �'�s-� --- G��� ( Mac.
Description of Work U ConstT
YPe
# Stories # Units (if Res)
New/Add SFF Remodel SFF
OWNER'S NAME Last rp� --, -k- w
First)
Ma pwj, �(/Q
edal/Labor
-
Owner's Address Owner's E-mail Address
_7-7.5_
City Z Q , .Z oc State Zip 7 Telephone 3
�- 4 r1--- 49 -Z m b"9
APPLICANT'S NAME Last nn,< liFg V r '"S 5� First VA
Applicant's Address
State
City 14c
ARCHITECT/DESIGNER'S NAME Last
Architect/DesignersAddress p
C� �r-I2�Sz0 �4�e_ iko:y
City � v, V tN L State TA
Applicant's E-mail Address
�T4VA,b(5��Qdt gSa1,„g. G
Zip 7 5 3- Telephone gl.t9 29
92 33 6 d
First Lic. No. —
Architect/Designer's E-mail Address
Zip 9 z 6 _I 2 Telephone 9� 9 .3 3 2 6 i
ENGINEER'S NAME Last First Lic No.F --
Engineers Address Engineer's E-mail Address
City State .^ Zip F_— Telephoned.
CQMRACTOR'S NAME/COMPANY Lic. N,11,� Class
Contractors Address Contractors E-mail Ad s
---
\tY )4J2 S �, State, Zip 92_`?30� Telephone049.7n Zt,za
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SETBACKS A SETBACKS FRONT
SETBACKS EF SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
PERMIT NO. XZ0Z-i '650-1
PLAN CHECK N 1
PLAN CHECK FEES s 1