HomeMy WebLinkAboutX2021-1482 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division
(- Comm'I (� Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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(—VCuilding F_Grading F—Drainage F_Elec [_Mech
r'Plum CuYdCut CuvdFill
Project Address (Not mailing address) f- Flood
r Fire F- Liq ( Landslide FN/A Floor Suite No
Description of Work
Use F Const Type
A:b-0 -36, 0 L-t ✓, of C'iftW
t1r A,"A
# Stories # Units (if Res)F
/VELD
Valuation $
Material/Labor 7� DC<2i .
New/Add SFRemodel SFGarage/New/Add
OWNER'S NAME Last C. Lill v First
Owner's Address
Owner's E-mail Address
r S� 9 am- c./�
City �.� t�1 State s A 1a
Zip 26 : Telephone
APPLICANT'S NAME Last cJ�L.L-
First I
Applicant's Address
Applicant's E-mail Address
City State F_
Zip F_ TetephoneF
ARCHITECT/DESIGNER'S NAME Last t L_ First5'G/ y4�-T?.l Lic. No. w
Architect/DesignersAddress
Architect/Designer's E-mail,
Z 5?6 ( &tt$rt(26 A L._�i
Address
L(1e SKyth6.PmES-Cz v,
City 1j- NTfAJ*TbAl 2r-A-r_H State FCA
Zip C� � � Telephone 7/f, g6j Y6 do
wGINEER'S NAME Last F:�) 2 i3 CFs
First �jr\ C Lic. Ncil:�_
CAddress
Engineer's Address
Engineer's E-mail
City State F_
Zip F_ Telephone[ -
CONTRACTOR'S NAME/COMPANY
Lic. No. lass
18 (((..• (VV
Contractors Address
I
Contractors E-mail Address
City F_ State F-
Zip Telephone
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $