HomeMy WebLinkAboutX2021-1655 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
F Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
'Building j-' Grading r-Drainage r Elec j- Mech xplum
Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) F Flood F Fire r— Liq r— Landslide F N/A Floor
1-7 2 G 4 Ilve r ,e�.
of Work
_'tFes _I A} -A! O ?fk c
S
Suite No
Use F Const Type F
TALL GNIv ,SLEC',e' �X7��JC,�
# Stories) j # Units (if Res)r/
New/Add SF F_ Remodel SF �— Valuation $
Garage/New/Add �— Material/Labor
OWNER'S NAME Last I CNER N'E� First J /
Owners Address
Owner's E-mail Address
1 i Z o z�Nus An .
City /t.i13 State ('J} ZipFj Z `��j'.
Telephone ,
APPLICANT'S NAME Last Fol 4�;cN
Applicant's Address
2 7 2 s� Cc�s r y>N ;/ s t.' )7E A
city cTJM state C'�
ARCHITECT/DESIGNER'S NAME Last S'F
Architect/Designer's Address
city F— State �----
ENGINEER'S NAME Last I FMBE7
Engineer's Address
l r� �. i�sT i rti/-T
City I S. A NTA 9V A State I Z •'
CONTRACTOR'S NAME/COMPANY
Contractor's Address
City
First) 6XIC
Applicant's E-mail Address
Zip � 2,; "7 5 Telephone `1 � c1 , i F - S' E ,-:: V
First) Lic. No. G - 31-f j
Architect/Designees E-mail Address
ZIP [---- Telephone
First I N LC Lic. No.F—
Engineer's E-mail Address
C4a/f C esi{n�e; c erg
zip I----- Telephone � ILf . �35 2&00
Lic. No3Wr Class 1
Contractor's E-mail Address
State [_ Zip F_ TelephoneF—
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK .
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $