HomeMy WebLinkAboutX2021-2768 - Permit ApplicationPrintFormi., Worksheet for Combo Building & Solar Permit Application
F- Comm'I r Residential City of Newport Beach - Building Division X2021 -2--tV g'
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
YT F_ Grading F -Drainage Elec
Project Address (Not mailing addres
CP y /3�L� /9 �id�T IVTzWt'0/?%
of Work
L
Tech um Cu Yd Cut Cu Yd Fill
F_ Flood (- Fire r Liq r Landslide
New/Add SFF__ Remodel SFF Garage/New/Add
OWNER'S NAME Last
Owner's Address
"// W,_ 2
�oI State
City G�f I/i/!.v.....
APPLICANT'S NAME Last
Applicant's Address
City LiS... V %/Z/lffl/ State
ARCHITECT/DESIGNER'S NAME Last je'y/.ljC/j%
Architect/Designees Address
City FC69 �6( J14_ State
F_N/A Floor Suite No
F77
Use Const Type'
# StoriesF_ # Units (if Res)
Firstl 1�i�nt�T
Owner's E-mail Address
y� B�o�Gr�aa G ✓. �/r�
Zip
First
a ?2
Applicant's E-mail Address
Zip�Telephone �
First Chwo;; Lic. No.C-5(2z S
Architect/Designer's E-mail Address
LO CA /DC
Zip Telephone ;/9, 1-2 C. ` 55 0,�
ENGINEER'S NAME Last First Lic. Nof—
Engineer's Address
City State
Engineer's E-mail Address
�T-..
Zip I�
CONTRACTOR'SNAMECOMPANYLic. No.�
—
9olass11 1/14S�1(�F
Contractor's Address
q9// w- C/m /,>Z- r -37a i Z - 6a
City 1;A3 V F J State FA-/—
SETBACKS
b' l/
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
Contractor's E-mail Address
Zip .F/// % Telephone Z),x _ 76
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEES $
$
(Valuation
Material/Labor�
-
Firstl 1�i�nt�T
Owner's E-mail Address
y� B�o�Gr�aa G ✓. �/r�
Zip
First
a ?2
Applicant's E-mail Address
Zip�Telephone �
First Chwo;; Lic. No.C-5(2z S
Architect/Designer's E-mail Address
LO CA /DC
Zip Telephone ;/9, 1-2 C. ` 55 0,�
ENGINEER'S NAME Last First Lic. Nof—
Engineer's Address
City State
Engineer's E-mail Address
�T-..
Zip I�
CONTRACTOR'SNAMECOMPANYLic. No.�
—
9olass11 1/14S�1(�F
Contractor's Address
q9// w- C/m /,>Z- r -37a i Z - 6a
City 1;A3 V F J State FA-/—
SETBACKS
b' l/
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
Contractor's E-mail Address
Zip .F/// % Telephone Z),x _ 76
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEES $