HomeMy WebLinkAboutX2021-1098 - Permit Application (2)Print Form Worksheet for Combo Building &Solar Permit Application orEW��m
F- Comm'1 r Residential
City of Newport Beach - Building Division o
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
f—Building FGrading F -Drainage [Elec 7_Mech F- Plum cuvdCut F Cu YdFill F
ject Address (Not mailing address) F_ Flood F_ Fire r Liq F- Landslide F_N/A Floor
of Work
Suite No
Use I— Const Type F
# Storiesr # Units (if Res)[—
Valuation
New/Add SF Remodel SF Garage/New/Add —, Material/Labor
3
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OWNS R'S NAME Lastt y-_vr_ First
Owner's Address Owner's E-mail Address
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APPLICANT'S NAME Last; (C' 3
Applicanit'sAddress
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City �;it C.1 State
ARCHITECT/DESIGNER'S NAME `"/ # A , L
Last ,.1-. €
Architect/Designer's Address
City ? State
First
Applicant's E-mail Address
Zip .j 1 ( 1 o Telephone
First VAC'13;'AS L'3 Lic. No.
Architect/Designer's E-mail Address
Zip Cts (g Telephone {..? •' �- ,.- r f a f,_ 9 �'+�
ENGINEER'S NAME Last I kDa V, lch First yam€ ty'r > -T�
Lic. No t. -Te kl-'.v:
Engineer's Address
City ` @�.� _ State �g
Engineer's E-mail Address
ZipL i -!`� _:_ .Telephone
CONTRACTOR'S NAME/COMPANYi- c �^Ta t s says s f d r} oE; Lic No. �f j;r Class!yty
Contractor's Address Contractor's E-mail Address
City =2'€`,Y1C(,\c Ctl�:,il{1Zi-jZSttaate (-
SETBACKS REAR
SETBACKS LEFT
USE ZONE
SETBACKS FRONT
SETBACKS RIGHT
DEVELOPMENT NO
Plii '}t c 9 ist 1y-, ; _ _
ZipG, i -;c- Telephone (t:-.
PERMIT
PLAN CHECK NO.
PLAN CHECK FEES $