HomeMy WebLinkAboutX2021-0700 - Permit ApplicationI Print Form I Worksheet for Combo Building & Solar Permit Application o4zEW�,m
r Comm'I F_ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAI
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F_Building F_Grading F-Drainage rElec FMech F-Plum CuvdCut CuvdFill [_
Project Address (Not mailing address) F Flood F_ Fire F_ Liq r Landslide F_N/A Floor Suite No
Lescription
of Work
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Use F—ConstType
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# Stories[— # Units (if Res)[ —
Valuation G� O 00 0
Material/Cabo
New/Add SFF Remodel SF�_-- Garage/New/Add
OWNER'S NAME Last M/1 First
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Owner's Address
Owner's E-mail Address
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City State Zip F-C TelephoneF
APPLICANT'S NAME Last (vCl First /[' y,}�/L
Applicant's Address Applicant's E-mail Address / Ma/
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City State `f!; Zip �'�'Jbd Telephone 7 / f -&63 -qsz5
GNER'S NAME t First r- Lic. No.
Address Architect/Designer's E-mail Address
Fhitect/Designer's
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State Zip TelephoneF
ENG 'S NAME Last 1 First I-�� Lic. No.�
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Engineer's AddressEngineer's E-mail Address
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City - ��.�{ State Zip Telephone U
CONTRACTOR'S NAME/COMPANY
j �J dQo /� _ 1 _ Lic. No. F�Class r
`A /W 7Contractor's
Contractor's Address E-mail Address
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City State CA, Zip -/ -/0S Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO. x 'Z�U 1 �,70C,
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. L269 3 - Z%Z.k
USE ZONE DEVELOPMENT NO LC i �� - "> (> PLAN CHECK FEES $