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HomeMy WebLinkAboutX2021-1457 - Permit ApplicationPrint Forrra Worksheet for Combo Building & Solar Permit Application o °R >m F_ Comm I j` tesidc M2 I ' I 5� City of Newport Beach -Building Division NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL c<��r��" f-euilding F_ Grading F -Drainage F_Elec )-Mech (-Plum Cu ydCut F_ cuvdFill [ v Project Address (Not mailing address)['' Flood I- Fire F_ Liq F_ Landslide F -N/A Floor Suite No Description of Work Use F— Const Type _ P V. # Stories, #Units (if Res) Valuation$ �d�© Material/Labor New/Add SFr---_— Remodel SF � Garage/New/Add F—' OWNER'S NAME Lastr-1 �lO1�1�0E%S _ Firstwr1,� Owner's Address Owner's E-mail Address V(e Esq b& 12d . CityF CCCOA-� ba Me*- State �� Zip ZZ& -&,5 Telephone w d APPLICANT'S NAME Last First ��, Applicant's Address Applicant's E-mail Address City I cos� ✓".edo� _.. State FCS Zip _ Y-2 27.._. Telephone �4; Z.G.-vte Z- _ ARCHITECT/DESIGNER'S NAME Last F First _ Lic. No. Architect/Designer's Address Architect/Designer's E-mail Address .. City �W State ' Zip F_ Telephoned'. ENGINEER'S NAME Last First _ Lic No. Engineer's Address Engineer's E-mail Address _.. City � State _.. Zip Telephoned CONTRACTOR'S NAME/COMPANY �t Gc Solar Lic. No. 162cZ&-7 Class cyi&TB Contractor's Address Contractor's E-mail Address City GCS -� r • _.. _.. State F Zip Cy7� Z-7 Telephone /vas'{�.t�q -.3G 3 3 _. G,�r SETBACKS REAR SETBACKS FRONT PERMIT NO. I I �,S �- SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. USE ZONE DEVELOPMENT NO PLAN CHECK FEES $