HomeMy WebLinkAboutX2021-2568 - Permit ApplicationPrint Form J Worksheet for Combo Building & Solar Permit Application Ow
F- Comm'I F_ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F-Building j- Grading
F-Drainage F-Elec F_Mech
f- Plum CuydCut F CuYdFill F
Project Address (Not mailing address) F_ Flood F_ Fire r Li slide _N/A Floor Suite No
Description of Work
Use F ConstType
# StoriesF. # Units (if Res)F_
Valuation$ Flo,,,)
Material/Labor
New/Add SF�—Remodel SFF —, Garage/New/Add F:
OWNER'SNAME
Last L. E s _-)-u N
First
Owner's Address
Owner's E-mail Address
21�, Vib 7VC-V�, vL
City I tJ Cw f,t
State (A_
Zip F_. Telephoned
APPLICANT'S NAME
Last
I First
Applicant's Address
Applicant's E-mail Address
City
State F_,
Zip F— TelephoneF_
ARCHITECT/DESIGNER'S NAME Last
First F Lic. No.
ArchitectlDesigner's Address
Architect/Designer's E-mail Address
City �
State F_,
Zip [—TelephoneF-
ENGINEER'S NAME
Last cv\5 -n �-t_ 10
First �/t,q-,2.F� i4a , j1O Lic No.�—
Engineer's Address
Engineer's E-mail Address
�C) I
Cl/K TiL L L) e .Q G, l tJ C:PE ✓2_1 !`)
City LO rJ b (j L ` i State �)/+.
Zip � U f� 13 Telephone (�f`��(, 1,
CONTRACTOR'S NAME/COMPANY O ILL ti . Th �� C Lic No. 3 i I a Class
Contractor's Address
Contractor's E-mail Address
1 1 to
To L-
City p t_,n. ,U D
State cv).- .
Zip GI I n �� Telephone t -' �✓�j"F _ 1 �p;7
SETBACKS REAR
SETBACKS FRONT
PERMIT NO. L002.1 1 2
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO. zo
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $