HomeMy WebLinkAboutX2021-2359 - Permit ApplicationSEW Poq
ition a
Print Form Worksheet for Combo Building &Solar Permit Applic
City of Newport Beach - Building Division
r Comm'I �( Residential NOTE. PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Cu
Cu Yd Fill
g Draina e N/A Floor Suite No
r Building [— Grading I— 9 Fire Liq Landslide F
Project Address (Not mailing address) I� Flood
Use ConstType F
Description of Work
0 # Storie5F # Units (if Res)r'
Valuation 5 Fi�
Rom' Material/Labor
New/Add SFr------
Remodel SF�--- ✓ '� Garage/New/Add
OWNER'S NAME
Owner's Address
City �—
APPLICANT'S NAME
Last
\%�vA �, V ` ^ First CAYRct/
Owner's E-mail Address
State Zip
Telephone-----
Last I 7�4 l w
Applicant's Address
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1 +✓�' u��'�`- State a
City jJEu/ Q
ARCHITECTIDESIGNER'S NAME Last
ArchitecVDesigner_ s_ Address
State r�
City
--- Firstr i
Applicant's E-mail Address \ 1
-1-«C\,i.0 (rvt r �P. YlC- (\ L�. 1. C'L•�`/�
Zip Telephone
ll
FirstLic. No.r------_—
Architect/Designei's E-mail Address
Zip r� Telephoners'
First
Lic No.r�
ENGINEER'S NAME Last
Engineer's E-mail Address
Engineer's Address.
r �- State F�
Zip �— , TelephoneF
City I Classy-----
Lic No.
CONTRACTOR'S NAMEICOMPANY Q41v,101-
Contractor's E-mail Address
Contractor's Address_
Zip �— Telephone�—
State r-- n A -
City nAAi'I ✓1C3 _
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SETBACKS REAR
SETBACKS LEFT
')NE
SETBACKS FRONT
SETBACKS RIGHT
DEVELOPMENT NO
PERMIT N0.
PLAN CHECK NO.
PLAN CHECK FEES $