HomeMy WebLinkAboutX2021-3080 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application o EW�gm
F_ Comm] Residential City of Newport Beach - Building Division 9 p a
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
r`Building F_GradingF-Drainage F_Elec rMech
rPlum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) F_ Flood r Fire r" Liq r Landslide F_N/A Floor Suite No
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Description of Work
Use l ConstType l
#Stories #Units (if Res)
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Valuation $
Material/Labor
New/AddSFF_ Remodel SFF-Garage/New/Add
OWNER'S NAME Last MCC /} J
First HL LL_C
Owner's Address
Owner's E-mail Address
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City State �(%h-
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Zip Zi 6 ( Telephone �y l • JI S ��l
APPLICANT'S NAME Last SL G t/
First
Applicant's Address
Applicant's E-mail Address
6 a. V:.0
City L/} E;U State
Zip Cj(d / . Telephone
ARCHITECT/DESIGNER'S NAME Last l4-E}r7 First Lic. No.LI+, L J t
Architect/Designer's Address
Architect/Designer's E-mail Address
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City I tA �:J cl N 1: /l LV, State FCf
Zip a � rj.. Telephone
ENGINEER'S NAME Last I First / 4% J- u Lic. No. S Tl y g 7
Engineer's Address
Engineer's E-mail Address
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City Pi e 64State G /�}-
Zip ?z S ( Telephone Q `i�j - 7is d77s
CONTRACTOR'S NAME/COMPANY �c,� Lic. No. ?SzI Class
63 `juit-Dc�S �rL
Contractor's Address
Contractors-E.-.mail Address
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City J rJ &q cx,y State �—
Zip 1 76 T Telephone TYL
SETBACKS REAR SETBACKS FRONT
PERMIT NO. 'A -,
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
v
170
PLAN CHECK FEES $'