HomeMy WebLinkAboutX2021-0395 - Permit Application�'ritif l=orm j VV®rksheet for Combo Building & Solar Permit Application
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F Comm'I P< Residential City of Newport Beach - Building Division
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUB AL
uildin g F Grading F-Drainage F Elec Mech
I- Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address)1-' Flood
j— Fire (-, Liq F_; Landslide r-N/A Floor
Suite No
F_ F_—
Description of Work
F� -Tv2.i _ Use �Const TypeFv7is
# Stories # Units (if Res)
New/Add SF g Remodel SF5 T- -- �— Valuation $
-� Q Garage/New/Add �— Material/Labor '�
OWNER'S NAME Last
First , r _J EI
Owner's Address
Owner's E-mail Address
City
State Zi P Teleph_ -
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APPLICANT'S NAME LZ
Last � van �
..�---� First -/�
Applicant's Address L7- ,.
�- Applicant's E-mail Address
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City F State
Zip ��63 Telephone _ (0
ARCHITECT/DESIGNER'S NAME _ 2--
Last 0 First
y' Lic. No. `d
Architect/Designer's Address Architect/Designer's E-mail Address
City I State
- _ ZiP Telephone
ENGINEER'S NAME Last � 1-—
0 -� ✓ -e- ✓-' First Lic. No.
Engineer's Address Engineer's E-mail Address
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City State
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CONTRACTOR'S NAME/COMPANY
�`� Lic. No. F� Class F-
Contractor's Address
Contractor's E-mail Address
City I State F-- -
ZiP [ Telephone
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
PERMIT NO. A, , 07-1 '- Ul J
PLAN CHECK NO. IV i� V j/(
PLAN CHECK FEES