HomeMy WebLinkAboutX2021-2684 - Permit ApplicationPrint Form 'p Worksheet for Combo Building & Solar Permit Application
F- Comm'I F-.,, Residential City of Newport Beach -Building DivisX
ion ��..'L� t1 l o
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL i aw '
FP -41 Iding j -Grading F -;Drainage F_Elec F_Meth F, Plum Cu Yd Cut F Cu Yd Fill
Project (Not mailing address) F_ Flood F_ Fire f- Liq r, Landslide FN/A Floor Suite No
\Address
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Description of Work
Use 'Const Type
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StpriesF # Units (if Res)F_�j
(A#
Valuation$ z/
Material/Labor Jv
New/Add SF . l Remodel SF F —� Garage/New/Add F—
OWNER'S NAME Lasth e First yt� Ct
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Owner's Address Owner's E-mail Address /
CitF EK
y b Squat"e-I Zip -! Z(o�2 Telephone 7 72,5 f��"
APPLICANT'S NAME Last , yytS First VV\,Q J
Applicant's Address Applicant's E-mail Address
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City r ( State C l� Zip Telephone
F W-4 lCr 3 7 _ (o 36 1
ARCHITECT/DESIGNER'S NAME Last®, I First r
Lic. No.
Architect/Designer's Address Architect/Designers E-mail Address
City State F Zip F Telephone
ENGINEER'S NAME Last iY1 n Sot) First Lic. No.F_
Engineer's Address r Engineer's E-mail Address
12,,6( is _ rtvs'hV\. Otq+44-_ pool, Ln , L wt _
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City iZ%tvj State r Zipat,zFo-7 Telephone 61) 6160
CONTRACTOR'S NAME/COMPANYLic. No. 7 VoLf Class�D
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Con]ttractor's Address Contractor's E-mail Address
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City �/ I State I �W Zip -' Telephone[ '7/ 7p w'�Ce
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. 7,327-ZIi1
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