HomeMy WebLinkAboutX2021-2258 - Permit ApplicationFrmtfnrm, -. Worksheet for Combo Building & Solar Permit Application
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Comm'I Residential City of Newport Beach - Building Division Zt 3 r .U, IsNOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
,,r Building F_ Grading rDrainage rElec rMech F -Plum CuvdCutF CuvdFill
�Project
Address (Not mailing address) Flood F Fire j Liq r Landslide N/A Floor Suite No
Description off Work
User: Const Type °
# Stories # Units (if Res)
Valuation $
Material/Labor0, CLv
New/Add SFRemodel SF Garage/New/Add
OWNER'S NAME Last
c ! � q Cs 3 First
Owner's Address.
Owner's E-mail Address
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State F— Zip I Telephone
APPLICANT'S NAME Last
First ,
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Applicant's Address
Applicant's E-mail Address 4
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City
State e, r` Zip --c Ltdro 7_ -_,,, Telephone—
ARCHITECT/DESIGNER'S NAME
Last First 1 377
Y C_, Lic No. c +/ 15 /4
Architect/Designne}r's Address
Architect/Designer's E-mail Ad ress
City G.-"✓ -_..
-_ State �— Zip— Telephone® -
ENGINEER'S NAME Last
First F_ Lic. No.F_'
Engineer's Address
- Engineer's E-mail Address
City
State r— Zip-- Telephone—
CONTRACTOR'S NAME/COMPANY
Lic. No.to A kClass
11 (S)�fafiD _.
Contractor's Address
Contractor's. E-mail Address
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City I alA Cl, jll t,IiW;
State FE ` Zip . Ov 4' Telephone L L(q g 75 U L�r
S BA EAR
SETBACKS FRONT PERMIT NO.
f=TB"Nr S, EFT
SETBACKS RIGHT PLAN CHECK N0.
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