HomeMy WebLinkAboutX2021-2966 - Permit Application1, Print roimn
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Worksheet for Combo Building & Solar Permit Application
f�- Residential
City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
f—<Tuilding F_ Grading F_,Drainage f— Elecf—Mech — Plum Cu Yd Cut Cu Yd Fill
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Project Address (Not mailing address) F Flood
F-, Fire f—Landslide r_N/A Floor Suite No
4n) --Fugf�- K) Liq F_ F_
Description of Work
art? 15)c ( 5TI N SUse Const Type
# Stories
Units (if Res)
FTNew/Add SFF7777Valuation $ 7 Remodel SF Garage/New/Add Material/Labor
OWNER'S NAME Last First
Owner's Address
Owner's E-mail Address
City State
Zip F Telephone[ --7—)4- 2A
0 Z_
APPLICANT'S NAME Last First
Applicant's Address pplicant's E-mail Address
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city State
zipTelephone[J75, lRiOTS, -7--
ARCHITECT/DESIGNER'S NAME Last
Fp,�V_W ------------- First Lic. No. F7777
Architect/Designel`s Address Architect/Designers E-mail Address
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City State ZIP R,7&7,//a Telephone f.Vq V-2, I I L4
ENGINEER'S NAME Last F7777777First Lic. No.
Engineer's Address Engineer's E-mail Address
City State Zip Telephoner:--- 4-ff ---- --
CONTRACTOR'S NAME/COMPANY�LV ?7Vr�rx Lic. No. Class
C I-Lmctorps a �rs s Contractor's E-mail Address
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City State ZIP FC;�__,7_7 Telephone F-7__J� �-,�Ve C)7,3--,7_
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SETBACKS REAR SETBACKS FRONT PERMIT NOX�Xjsql;
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.