HomeMy WebLinkAboutX2021-2626 - Permit Application/( Print Form Worksheet for Combo Building & Solar Pei
L- Comm'I r esidential Cof Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBi
F --Building F_ Grading F -Drainage rElec F_Mech (Plum Cu Yd Cutl Cu Yd Filll
Project Address (Not mailing address) F_ Flood r Fire F Liq F- Landslide FN/A Floor Suite No
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Description of Work Use F—Const Type F
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b# StoriesF_ # Units (if Res)F—
Valuation $
New/Add SF� Remodel SF Garage/New/Add F— Material/Labor i (000
OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
City State I Zip F— Telephoner
APPLICANT'S NAME Last J M ACAA-t>(D First I `DRu ti)
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Applicant's Address L Applicant's E-mail Address t
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ARCHITECT/DESIGNER'S NAME Last I`! 0m,+e-6 FirstGc�a��S_ Lic. No.
Architect/Designees Address
City State F—
ENGINEER'S NAME Last cr�el SSu7
Engineer's Address
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Architect/Designees E-mail Address
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Zip F Telephone ZS, f GC!:
G1Gi% First � 1p-t%vV eZy Lic. NO
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Engineer's E-mail Address
Zip I ` C)Z+& Telephone 3 (0 iOCS SLS p�j
CONTRACTOR'S NAME/COMPANY ��y ic.No. R�( 32� Class
Contractor's Address
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City rJv�II"- State Qc`
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
Contractor's Et ---mail Address j
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Zip 1 9iTelephone[S
PERMIT NO. )(= — .(p X2-(0
PLAN CHECK No. ZZgb -Z6-7,j
PLAN CHECK FEES $