HomeMy WebLinkAboutX2021-3318 - Permit Application1=rint Form Worksheet for Combo BOA & Solar P i io ?� "°
KComm'I r Residential City of Newport Beach -Building Divisi
NOTE: PLAN CHECK FEES DUE AT TIME OF SU%T
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>�8uilding r Grading F Drainage '<Elec 1114, e c h /Plum CuvdCut Cu Yd Fill F
Project Address (Not mailing address) F= Flood F_ Fire F- Liq F_ Landslide [_N/A Floor Suite No
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Description of Work
Use I j 1) Const Type
Stories', # Units (if Res)[
Valuation $
Material/Labor
New/Add SF F_Remodel SF Garage/New/Add
OWNER'S NAME Last I �.
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Owner's Address (4 Owner's E-mail Address
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City State Zip
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APPLICANT'S NAME Last y� �. First rn19
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Applicant's Address Applicant'sE-mail Address
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City I r))1Sf •`r V. ,MOT) State Zip l(Opa, Telephone (a,4Q1
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First
ARCHITECT/DESIGNER'S NAME Last n K
Lic No.-
Architect/Designer's Address Architect/Designer's E-mail Address
P r- c.441 —q k 107M W. �H�ta�WiO�
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City (�rKL�rn /�4 �F State r Zip 14T_ Telephone
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ENGINEER'S NAME Last Lic. No.
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Engineer's Address - Engineer's E-mail Address
City State F_ Zip I— Telephone F_
CONTRACTOR'S NAME/COMPANYr & W IL4 Lic. No. IP �>t Class
Contractor's Address Contractor's E-mail Address '64
City State F_ Zip Telephoner--.--------.
SETBACKS REAR SETBACKS FRONT PERMIT NO. M_
SETBACKS LEFT SETBACKS RIGHT PLAN CHEC O. r "
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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