HomeMy WebLinkAboutX2021-3384 - Permit ApplicationPrint Farm Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division
F_ Comm'I Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL J
Building F Grading (—Drainage F Elec r Mech r Plum cuvdCut F cuvdFill F
Projecti
Address (Not mailing address) I— Flood I" Fire f— LqF, Landslide I —N/A Floor Suite No
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Description of Work
Use '�:,V-:, ConstType Uy,
RAVE •&OT�'
#Stories !, # Units (if Res)F1
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New/Add SF Remodel SF , 1 Garage/New/Add
Valuation$
Material/Labor
OWNER'S NAME Last /�'i� . -...
First
Owner's Address
Owner's E-mail Address
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City —
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1t
Telephone Zip
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City �.. �' State
ZipIt -:���*,,�;- Telephone `'� ,ZS
ARCHITECT/DESIGNER'S NAME Last V l: First ¢IU. � Lic. No. F__
Architect/Dessii.gyne'rr''s'Address
Architect/Designer's E-mail Address
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/%zn//I
City I / % " I wr— State —
Zip Z Zcr, Telephone
ENGINEER'S NAME Last %� -
First � `�°° ���� �- Lic No. _7
Engineer's Address
Engineer's E-mail Address
17%e�2 a147 i j .t U_
C fiZ��C�rGS,F�Ir.� G.Ti K)411 C� . A-C:k... - CrL'S tl' I
City �.}.�N�-p^j�'�"a _• State �_
Zip '1 Telephone 7'j4, V7,7 1
CONTRACTOR'S NAME/COMPANY cv /AA C�a Lic No. $�4 aClassM
Contractor's Address
Contractors E-mail Address
City s° �4;t State F7,,�-
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Zip >..,>,t; Telephone ��
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. I"1r1-24��
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $