HomeMy WebLinkAboutX2021-2948 - Permit Application�,. Pir;t Form' Worksheet for Combo Building & Solar PermitApplication'°Rm
(- Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMI Irjy O Fow"
(-Building F_Grading r -Drainage F_Elec F-Mech Fm Plum cu Yd cut Cu Yd Fill
Project Address (Not mailing address) F_ Flood F- Fire I- Liq F- Landslide F_N/A Floor Suite No
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Description of Work Use F—ConstType
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# Stories #Units (if Res),
Valuation $ °
New/Addb`4 SF RemodelSF� Garage/New/Add Material/Labor
OWNER'S NAME Last I 114414- First 3ev, (2-3,/
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Owner's Address Owner's E-mail Address
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City FPA , Q eaCH State G Zip[ Telephone
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APPLICANT'S NAME Last�/� f First I T&
Applicant's Address Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last First N as; wx Lic. No. F__
Architect/Designer's Address Architect/Designer's E-mail Address
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City L45uln�\��i� State I v� Zip �{dGS3 Telephone / /-a,I3-CJi'ji�
ENGINEER'S NAME Last � G � k� M ; First � ; f Lic. No. �,v I q
Engineer's Address Engineer's E-mail Address
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CONTRACTOR'SNAME/COMPANY SXR L,/ ��CF Lic. No.gwnn Class
Contractor's Address `` 4/ , ! Contractor's E-mail Address �%�� /
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City Nw,�C}_2CxC (- State G ZiP �j��e(0 Telephone 3IC� ��% f �6
SETBACKS REAR SETBACKS FRONT PERMIT NO. �CZaZ I -p ZEN
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. 2S$ 1^ZOZ1
USEZONE DEVELOPMENT NO Pg0Z(- 0578PLAN CHHECKECKFFsj0
EES $ iS