HomeMy WebLinkAboutX2021-0091 - Permit Application (3)Print Form I Worksheet for Combo Building & Solar Permit Application
j- Comm] �° Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF RI IRMITTAI
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Project Addrepps��s��(Not mailing address) F_ Flood J-`'1Fire (` Liq ( Landslide FN/A Floor Suite No
Description of Work
Use )/ConstType �-
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# Stories # Units (if Res)f
Valuation $
Material/Labor 14p0 ��
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New/Add SF �j RemodelSF7_
Garage/New/Add S6
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OWNER'S NAME Last ` Y- ei / !`- r /
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First Z+ -
Owner's Address
Owner's E-mail Address
47� a GOWN
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City A�l�tdP012r BA.v'n /J State ��
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Zip j12
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APPLICANT'S NAME LastI v c
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Applicant's Address
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Applicant's E-mail Address
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city I cfi/rl State
Zip �/ 5 Telephone' ". $e7. Ss s,56
ARCHITECT/DESIGNER'S NAME Last f � First F �—
Lic. No. CI J�
Architect/Designer's Address
Architect/Designers E-mail Address /
City F State
Zip F— Telephoned-----
ENGINEER'S NAME Last
First I f>� — Lic. No.
Engineer's Address
Engineer's E-mail Address
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City F N%" State �—
Zip FtT 2701 Telephone [7/¢-r g 35- 2
CONTRACTOR'S NAME/COMPANY F_
Lid. No. F_ Class w
Contractor's Address
Contractor's E-mail Address
City F' State
Zip Telephone
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO UtD- b1}tila PLAN CHECK FEES $