HomeMy WebLinkAboutX2021-2305 - Permit Application1P
Print Form Worksheet for Combo Building & Solar Permit Application
F Comm'I 'V/ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building F_ Grading 't<Drainage XElec F- Mech J— Plum cuvdCut F_ cuYdFill
Project Address (Not mailing address) F- Flood (— Fire [_ Liq (— Landslide rN/A Floor Suite No
2`� (xm \n6A s ]>r
C-,DM Get 9&Z"S
Description of Work
Use I ConstType F_
#Stories #Units (if Res)
E*k6aC V;ll cuckl�
Valuation $
Material/Labor
New/Add SF� Remodel SF�
Garage/New/Add F
OWNER'S NAME Last
,•��nl(A
First S(u;*
Owner's Address
�121 Cameo V614laeds Dr CON1 Cak 9 2uzS
Owner's E-mail Address
Secst� C Walloon .�eaeti -_
City State C♦A(�
Zip C12605 TelephoneFGD;�_722-g750
APPLICANT'S NAME Last )l%G�p
First .�
Applicant's Address
Applicant's E-mail Address
_
1440 aixi(e SJ
Vg2�61%S+e jhuj,t. c�..
City ��Q State
Zip �(r2'j Telephone] 9yg_ �fl9-o73�
ARCHITECT/DESIGNER'S NAME Last �
1,1
First Lic. No. 5 9
Architect/DesignersAddress
ArchitecUDesilgner'sE-mail Address
� IZ79 &l�rneyr Srl # 14(r
Cray Cedl Ia.C�
City I! L_t;4 (f�a"'"' State IPA
Zip I 92W j Telephone B0D-p11-3p10
ENGINEER'S NAME Last W 1 I� ,
First � P Lic. No. '�
Engineer's Address
2 0052 Gaw.�.no Ca.0c3n0 St, 2J3
Engineer's E-mail Address
Will &ailsca f s .co,,,. ---
CitY '� M rTState
�LVC,
Zip �l;o- 7 Telephone g. 8i�s
CONTRACTOR'S NAME/COMPANY A j
1/yI
Lic No. Class I`
Contractor's Address
Contractor's E-mail Address
City State
Zip TelephoneF�
SETBACKS REAR SETBACKS FRONT
PERMIT NO. x Ld ZI 2� oS
SETBACKS LEFT /, SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $
2S`l5,7I