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HomeMy WebLinkAboutX2021-0964 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application aq, F- Comm'I �tesidential City of Newport Beach - Building Division NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL Building Grading r`Drainage F_ Elec r Mech F_ r Plum CuYdCut CuYdFill Project Address (Not mailing address) loo F_ Fire r` Liq r Landslide rN/A Floor Suite No LJ t_-i Description of Work Use F—Const Type r. t�s' cal,(") # StoriesrZ # Units (if Res)F �J I �L A- k� k) �Ct e�v� V, i rti �ti ( IZ 1 >; (1 j�,� c,1, 6�, , Valuation $ U1� Material/Labor UV� New/Add SFr'--"----- RemodelSFF— Garage/New/AddF— OWNER'S NAME A Last First i ci,-r � Ow�Address Owner's E-mail Address erner's k City ,4-y+ i _ Y,.� State ��� -� Zip �� Telephone T�L/ j71 ._�, -�� APPLICANT'S NAME Last �I"11'� First 0 Applicant's Address Applicant's E-mail Addres�3ll .L )V7 City1.�� i L...� State L�. b Zip U�/ / ,.,ZG� Telephone LI / C� l t "E ARCHITECT/DESIGNER'S NAME Last T,,//�` — " ��, l i�1 \ �' (I'jl �� ( f L� Lic. No. r...--------- ArchitecVDesigner's�Address 'ArchitecUDesignertsEmail Address City IQj State. ( Zip ZC�; Telephone ENGINEER'S NAME Last .rty� 1 First �r,,�.L Ui; /., Lic. No. E 3"72La' Engineer's Address Engineer's E-mail Address City ��C IGtI i State �.-}� Zip �') /c>2 Telephone) — C CONTRACTOR'S NAME/COMPANY _ Lic No. �� Class�— Contractor's Address Contractor's E-mail Address City F_ State �_ Zip �— Telephone[ SETBACKS REAR SETBACKS FRONT PERMIT NO. SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. I J `. '; ' USE ZONE DEVELOPMENT NO PLAN CHECK FEES $