HomeMy WebLinkAboutPV2021-147 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application o�EW�ra
[- Comm'I KIResidential City of Newport Beach -Building Division E `
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F Building r Grading rbrainage i_Elec r"Mech r Plum cuvdCut F_ cuvdFill
Project Address (Not mailing address) F Flood Fire F-" Liq F` Landslide (-N/A Floor Suite No
%/l `lZ tin i� �, N art eac , GA 25 F F
Description of Work �� �
Use Const Type ly a
# StoriesF,--2# Units (if Res)F—
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New/Add SF 2J!{ . ZQ Remodel SF Garage/New/Add a/New/Add Valuation $
�F 9 r Material/Labor L-� ✓ P V - ,3 -
OWNER'S NAME Last T �t _[
✓( r�r✓!! I�Ci_�i/r First rp Ci_c CA&
Owner's Address
Owner's E-mail Address
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City I/1!✓ State ZipN r Telephone
APPLICANT'S NAME Last�FirstG Q/
Applicant's Address Applicant's E-mail Address
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City - State Zip Telephone
cUn f� hit Ci 9230 I � 96`)OJl0 15
ARCHITECT/DESIGNER'S NAME Last--
First Lic. No. �--'
ArchitecUDesigner's Address Architect/Designer's E-mail Address
77 1
' City State �--- ZiP[`---- Telephoned
ENGINEER'S NAME Last I First G G5g�-2
T�7 ry, � 0 Lic.No.
Engineer's Address Engineer's E-mail Address
City - State r---- Zip Telephone
CONTRACTOR'S NAME/COMPANY Lic
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Contractor's Address Contractor's E-mail Address
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. City afi fa Af%Q State C,;& . Zip qy . t Telephone [555 ?_?� q'7
SETBACKS REAR SETBACKS FRONT PERMIT NO. TV- Ah
SETBACKS
-
SETBACKS LEFT - SETBACKS RIGHT PLAN CHECK NO. -
Q
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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