HomeMy WebLinkAboutX2021-2988 - Permit Application (2);Pant Form; Worksheet for Combo Building & Solar Permit Application
Comm'I City of Newport Beach - Building Division X�2�..2g4px�
F_ [ Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
[.—Building [Grading Drainage f-Elec j—Mech F7 plum Cu Yd cut Cu Yd Fill
Project Address (Not mailing address) C Flood r Fire F-,' Liq r Landslide _,N/A Floor Suite No
1 S 1 q wT 5-7 f hn ------- ----- - — — -
Description of Work ry Use 11 Const Type t
F e -t w rpt, Q i- 9-Z fi! wit Q-ee 6v - c c tye rc Y J -o LF
#Stories #Units (ifRes)
Valuation $
New/Add SFL--, Remodel SF�—, Garage/New/Add Material/Labor/Of) C7
OWNER'S NAME Last
Owner's Address
City
APPLICANT'S NAME Last
A First
Owner's E-mail Address
State CJ9— Zip
Applicant's Address
City — — State �—
First
Applicant's E-mail Address
ZIPTelephoneTelephone�—
ARCHITECT/DESIGNER'S NAME Last First —
Lic. No. �—
ArchitectlDesigner'sAddress ------------ -�---- -- --- --- --
- ---------------
City State �—
ArchitecUDesigner's E-mail Address
Zip Telephone
ENGINEER'S NAME Last c,, e y 6Gc L,.k First G� ✓i g fz ,t / Lic. No fes, U—U—
Engineer's Address
City i1Lv�1.Ptnn -- — ---- State C�--_
Engineer's E-mail Address
Zip Telephone—
CONTRACTOR'S NAME/COMPANY i _ L SL G n r" Lic. No. Class
Contractors Address
D7J?J %F 't ✓ a 1� ��
City State
Contractor's E-mail Address
Zip�.... 3 Telephone
SETBACKS REAR I SETBACKS FRONT ZJ
SETBACKS LEFT J SETBACKS RIGHT
USE ZONE
DEVELOPMENT NO
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEES $
•3,021