HomeMy WebLinkAboutX2021-2784 - Permit ApplicationEl,.Print l orm , Worksheet for Combo Building & Solar Permit Application �4v'�'�R�
CommI ✓Residential City of Newport Beach -Building Division 1 a
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL��
rBuilding Grading rDrainage [Flet Mech Plum CuvdCut F Cu YdFill F
Project Address (Not mailing address) F Flood (-_ Fire r Liq F_ Landslide F_N/A Floor Suite No
Description of Work
Use ConstTypeF__
�3t-,oc�c �so��. ��. lt•�.��F'C X L. YT
# Stories # Units (if Res)F
.. ....._.......... - - - -I
Valuation $ /1� ri rjt
New/Add SF Remodel SF Garag a/New/AddF— Material/Labor
APPLICANT'S NAME Last I . LI -r_
Applicant's Address
City I V-) c 9 ,, -s -C3 State Fc7
First 1 -7 C_ A>
Applicant's E-mail Address
�oo��•`�--gC ® cox
Zip ^��4Qo Telephone , M.. 1033
ARCHITECT/DESIGNER'S NAME Last First F_ Lic. No.
Architect/Designees Address +
City � State F_
Architect/Designer's E-mail Address
-- _....... -
Zip Telephone[
—
ENGINEER'S NAME Last F First F Lic. Not
Engineer's Address
City State F
Engineer's E-mail Address
. ---
Zip I .. 11 1 Telephoned
CONTRACTOR'SNAME/COMPANY y 77, _ y g�„yt�6 ks Lic. No. Ib368ya Class
Contractor's Address
City �oofl c.>..h `c�-t.' State C�
SETBACKS REAR %'�;_
SETBACKS LEFT
FRONT
SETBACKS RIGHT
Contractor's E-mail Address
7'�C (l 4iWJttJ fL01 �9A`(-IrJ 1C4vu p, Co w.�
Zip °1 \ Telephone $1$, Asti , 163 a
6'Vj le -y PERMIT NO. I
/ PLAN CHECK NO..
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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