HomeMy WebLinkAboutX2021-0778 - Permit ApplicationPrintl orm Worksheet for Combo Building & Solar Permit Application o�`�`°�e
F- Comm'I r Residential City of Newport Beach -Building Division
NOTE: PLAN 6� ECK FEES DUE AT TIME OF SUBMITTAL c�.oa�'
sBuilding [Grading
rDrainage"VElec fKMech Plum Cuvdcuts� cuvdFill
'Project Address (Not mailing address) F Flood f- Fire F- Liq F Landslide F_N/A ,Floor Suite No
Description of Work
Use s ConstType F_ ,
# Stories # Units (if Res)s
Valuation $
Material/Labor
.New/Add SFF
Remodel SFF—_---- Garage/New/Add F---
OWNER'S NAME
Last11 First
Owner'sAddress
Owner's E-mail Address
City
State F Zip I— Telephoner
APPLICANT'S NAME
�G
Last First
Applicant's Address
Applicant's E-mail Address -
city % G :
(
... ) State /' _-� —. Zip ZTelephone f.1-�V 1 _3 -7 G '7 2-
ARCHITECT/DESIGNER'S NAME Last
�1 .vv�,CZ � First j\.�/,j",.(_ Lic. No.
Architect/Designer's Address
ArchitectlDesigners E-mail Ad.Cress
City r,-----
State F-- Zip r--------`: Telephone----
ENGINEER'S NAME
Last First. --y- Lic. No.F-------'
Engineer's Address
Engineer's. E-mail Address
City _
State r-_ Zip TelephoneF.��----
CONTRACTOR'S NAME/COMPANY
. .7 s
las
Contractor's Address
Contractor's E-mail Address
i Dl�i..� ti.l d O( Ajuti rc7 / r Y
City
State-- Zip Telephone- '/7 27 7 Z, a 0
SETBACKS REAR
SETBACKS FRONT PERMIT NO. l W2` — &?-W)
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. 071 6 �' ZCti7i�
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $