HomeMy WebLinkAboutX2021-1966 - Permit ApplicationPrint Form
f;;, Comm'I
Fuilding
Worksheet for Combo Building & Solar Permit Application
r Residential City of Newport Beach
A
lding Division
NOTE: PLAN CHECK FEES DUE ATITIIME OF SUBMITTAL
F Grading
rDrainage Ptlec
Project Address (Not mailil
Description of Work
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Pffi" Nvuf l . i
7Mech r" Plum CuYdCut F_
Cu Yd Fill
F Flood r Fire F_ Liq Y Landslide
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New/Add SFFZ� Remodel SF O
Garage/New/Add r-_
OWNER'S NAME
Last
�} Owner's Address First F—
_ LI I 1►`0� Owner's E-mail Address
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City 11'In� State II SIC l� zip ��%I 1 T.
APPLICANT'S NAMED
Last 1`n 6
Applicant's Address
City WOW
(f (N A wState
ARCHITECT/DESIGNER'S NAME
Last Sctd�1�S
Architect/Designer's Address t
First
Applicant's E-mail Address
F_N/A Floor
10
Suite No I
ifo
Use l ) Const Type FTA-
# Stories 12 # Units (if Res)[ —
Valuation $
Material/Labor St),
Q
Zip (/� Telephone'
vIULY I flisr 1 Lic. No. F—
Architect/Designer's E-mail Address
City
State F— Zip Telephoner -----
ENGINEER'S NAME
Last I !� I �,C
First F_ Lic No.r--
Engineer's Address ` /�
ij�� Engineer's E-mail Address 3 zJ D i
JLIA Cam. ova, . s-� co ,5(a�-��1 sc, ,corn
City ���� State I l rt
C zip v14b Telephoner --
CONTRACTOR'S NAME/COMPANY j g rt _
Y✓Gii Rfrm Ci w5 �rkc �7 a 1 Lic No. 63SI SG Classy 13
Contractor's Address I c: ;j ,+F �{ Contractor's E-mail Address
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`�'la"'°`n ��fryrt consfrvc�ravrl�S,caM
City I fV't yt.e State r [�— Zip R Z6 d z Telephone �
71y� q18 7688
SETBACKS REAR SETBACKS FRONT
SETBACKSLEFT SETBACKS RIGHT
USE ZONE
DEVELOPMENT NO
PERMIT NO.
PLAN CHECK NO.
ZoL( - I
PLAN CHECK FEES $