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HomeMy WebLinkAboutX2021-1216 - Permit Application (2). X2a2I -1216 370G Print Form Worksheet for Combo Building & Solar Permit Application -no �` °°"a F_ Comm'I j—' Residential City of Newport Beach - Building Division NOTE: PLAN CHECK FEES DIJF AT TIMF nF sl IRMITTeI [4euilding F_Grading [—Drainage [_Elec FMech Plum Cu Yd Cut Cu Yd Filll Project Address (Not mailing address) r— Flood Fire F— Liq F— Landslide [N/A Floor Suite No Description of Work Use�f Q 'Const Type " 64,Y), ,2 `lp C"e- # Stories # Units (if Res)[ �j Valuation $� 00 O Material/Labor `r---. New/AddSFr---- Remo11d',el11SFI IV Garage/New/Add—'' OWNER'S NAME Last W ©© First Q { Owner's Address Owner's E-mail Address urWxu, CFN ity r--- ---- State I Zip r— Telephone0 APPLICANT'S NAME Last t C Y First Applicant's Address Applicant's E-mail Address E014 k- W i &%TYT - _ City ._.. �fDs 'c9� �� Q` State � Zip r— Telephone qR_, -2 _E-AR� ARCHITECT/DESIGNER'S NAME Last First Lic No. ArchitectlDesigner's Address Archi//t��ectlDesigneerr's E-mail Address _. _. __. _ _._.... V6 p City State �— Zip Telephone _ _ _ _ ENGINEER'S NAME Last First F_ Lic. No.r---' Engineer's Address Engineer's E-mail Address City State I Zip �— Telephoned CONTRACTOR'S NAME/COMPANY 014 � Lic. No. �— Classr� Contractor's Address Contractor's E-mail Address City State r—'. zip �-,-- Telephone SETBACKS REAR SETBACKS FRONT PERMIT NO. SETBACKS LEFT - SETBACKS RIGHT PLAN CHECK NO. rte.,' USE ZONE DEVELOPMENT NO yc,VZl--1,t7.sl PLAN CHECK FEES $