HomeMy WebLinkAboutX2021-1025 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application 04".
City of Newport Beach -Building Division ��(( r Comm'Ir esidential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL ✓���a`� I���
F_ Building F Grading I —Drainage F_ Elec I— Mech Plum Cu Yd cutF_ Cu Yd Fill
Project Address (P+1®t mailing address) Flood Fire Liq Landslide N/A
Floor Suite No
F_
Dr- CIO
Description of Work
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aL �V�C?LJ1'1.i
New/Add SFF— Remodel SF
(' Use Const Type
S l �, do f l ✓l —
�) i J # Stories #Units (if Res)
Valuation $
Garage/New/Add F Material/Labor
OWNER'S NAME Last `Jav4°e_ �o'4. � First r7av1%C - ___.�.....-..W .�.�.
Owner's Address Owner's E-mail Address
Ill i 0 C �- 4'l
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City I Lo. ���j Gi� State v j v Zip �`� � 3 7� Telephone , 0 6 t 3 2 1
APPLICANT'S NAME Last I jr� vn.-l-P, �c),r d�
V X, I i o�
Applicant's Add ess
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City I K,64)o'l— �j�p G�.� State (�
ARCHITECT/DESIGNER'S NAME Last
Architect/Designer's Address
City
ENGINEER'S NAME Last
Engineer's Address
First L�
Applicant's E-mail Address
F/i _01 o a m ove) - (6
Zip Telephone �I9:; 3_. ✓ i
First
Architect/Designer's E-mail Address
State I— Zip � Telephone
First F
Engineer's E-mail Address
Lic. No.
Lic. No.F—
City �� � State F Zip �� Telephoned
CONTRACTOR'S NAME/COMPANY Lic. No. ClassF
Contractor's Address Contractor's E-mail Address
City State F__ Zip Telephone) k4 0
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT
SETBACKS RIGHT
PERMIT NO.
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $