HomeMy WebLinkAboutX2021-1564 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit plica/�021WMB(— Comm'I �C Residential City of Newport Beach -Building�i4NOTE: PLAN CHECK FEES DUE AT TIMV
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r Plum Cu Yd Cuts Cu Yd Fill
Project Address (Not mailing address) F_ Flood F- Fire r- Liq r- Landslide [N/A Floor Suite No
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Description of Work
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Use F—Const Type v ?
# Stories[ �% #Units (if Res)
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Valuation $
Material/Labor4512oeg
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New/Add SF Remodel SFn Add
OWNER'S NAME Last
First
Owners Addressi
Owner's E-mail Address
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City j. '` -P)04p,/.14 State
Zip 4`221 , Telephone lliq,�-79;o-ea-
APPLICANT'S NAME Last
First I _,JAI
Applicant's Address
Applicant's E-mail Address
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City Og�T%� _ _.. State I �"
Zip I'�r'_!U Telephone 11� �%f�l! Ar;1`;
ARCHITECT/DESIGNER'S NAME Last Z,j� First Y Lic. No. 21m)
Architect/Designer's Address
Architect/Designer's E-mail Address
4_-70 11►10-u9
City g+Q-{,%T.� i _ State Fe� —'.
Zip d ( Telephone
ENGINEER'S NAME x Last
--_--
First F_ Lic. No.F_
Engineer's Address
Engineer's E-mail Address
City State
Zip Telephone
CONTRACTOR'S NAME/COMPANY
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Lic No. F--------.- Class
Contractor's Address
Contractor's E-mail Address
City State F_
Zip F®. Telephone.
SETBACKS REAR SETBACKS FRONT
PERMIT NO. JC,Z-(_) Z. 15 6
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. ZZ `
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $