HomeMy WebLinkAboutX2021-3360 - Permit Applicationimp Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division o
I ❑Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Address (Not mailing address),C Flood ❑ Fire [] Liq F-1 Landslide f _;�1/A
61.E 0
Description of Work
W/21
New/Add SF Remodel Garage/New/Add
OWNER'S NAME Last
First
Use
�Floor
SuNo
�
.j
# Stories IKI It Units (if Res)E]
Valuation $
Material/Labor ^ �) �� —�
Owner's Address '
Owner's E-mail Address
City � ---1 State Zip I '7 Y� ! '�� Telephonel QM- `774 - • -rd
APPLICANT'S NAME Last
Applicant's Address
j l 2.
City DIGrt_- _ I State
First
Applicant's E-mail Address
I MCIyplxl M V-1--p-e- L. llpr I
Zip I W Z(o
ARCHITECT/DESIGNER'S NAME Last eK Op.j�;, First L(
Architect/Designees Address
cityfW GK� ��/� l State
12(;yr Z3>0
Lic. No. G» 0 ; N/y,
Architect/Designees E-mail Address
Zip 2�-_ # TelephoneLqi q ell - 4
ENGINEER'S NAME Last �`- — - First -- ,^ -_ �I Lic. No.0 _ __--1
Engineer's Address
City _- --- ! State C i
Engineer's E-mail Address
---- ---------------—____-- -----=---•--_.__.._------
Zip—j Telephone
CONTRACTOR'S NAME/COMPANY 1 G ��. �Mi Lic. No. Class
Contractor's Address •
City State
I
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
Contractor's E-mail Address
Zip Y Telephone i I -----------
I-
PERMIT NO. I
PLAN CHECK NO. _ 1
PLAN CHECK FEES $