HomeMy WebLinkAboutX2021-0261 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
IF Comm" residential City of Newport Beach - Building Division X jai - UZ,(eI
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
A 0
F_Building F Grading j—Drainage F_ Elec F_ Mech
F Plum CuYdCut CuYdFill F
Project Address (Not mailing address) F_ Flood
F_ Fire F_ Liq F_ Landslide .Af\I/A Floor Suite No
l710 �L �i '_2 �)1V� , ALAN Mfr[ (74 9z66d F r
Description of Work
Use F ConstType
v LS"
# Stories[— # Units (if Res)F_
Valuations
Material/Labor v v
New/Add SF Remodel SF Garage/New/Add
OWNER'S NAME Last �/?
First P(4AJA
Owner's Address
Owner's E-mail Address
310 �N#G "Nivz
City N v 4t1 (V,C t 84w State I (Y/
Zip F Telephone0
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City I State m
Zip Telephoned
ARCHITECT/DESIGNER'S NAME Last
First Lic. No. j
Architect/Designer's Address
Architect/Designer's E-mail Address
City State F_
Zip [— Telephoned
ENGINEER'S NAME Last 1`>
t'I v
First Lic. No. T 6epe
Engineer's Address
Engineer's E-mail Address
City CH I /Vl/ State FCA
Zip y��w Telephone gp�. 6�� -• 27�
CONTRACTOR'S NAME/COMPANY 1 if)1 y� l,p
r 01q_C>il j)('Tt� ) c Lic. No. 0) l`��
f
L
Contractor's Address
'Cllass7
'
Contractor's E-mail Address�,I,
546v nI. I'-7
cA1Yrur' (j 6' �iYXIc.co -( 1a31-74
City A(A State I C A
Zip (%r po6 Telephone _ � )4/
J
SETBACKS REAR SETBACKS FRONT
PERMIT N
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. ?_ 1,190
USE ZONE DEVELOPMENT NO
• PLAN CHECK FEES $