HomeMy WebLinkAboutX2021-1343 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application ora
F_ Comm'I Residential City of Newport Beach - Building Division .
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL °<•oa"''
Building r Grading rDrainage j-Elec rMech F-" Plum Cu Yd Cut Cu Yd Fill F
Project Address (Not mailing address) C Flood F- Fire r Liq F- Landslide CN/A Floor Suite No
Description of Work
Use Const Type
#Stories #Units (if Res)
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i f{VY Qi �.FI TINI 5, >i�(�O•✓`�. /�I $I Cl4'�'..�
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Valuation $
New/Add SFf ------ Remodel SF f _-- Garage/New/Add 0—
Material/Labor 2
OWNER'S NAME Lasta (o j (/" First Z{y�
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Owner's Address Owner's E-mail Address
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Cityeu a j _ _T}ztoL.._. State Zip q?-Cc.0 Telephone (akn) qL_ 9-ry0I9
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
—
City State I— Zip F_ Telephone-
ARCHITECT/DESIGNER'S NAME Last First Fs— Lic. No. F_
Architect/Designer's Address Architect/Designer's E-mail Address
City State F- Zip F_ Telephone F—
_- -_-_ Lic. No.F T 5FU-
ENGINEER'S NAME Last First F_
Engineer's Address Engineer's E-mail Address
city State I— Zip F_- Telephone--
CONTRACTOR'S NAME/COMPANY K71Z5 hrvi�o�ra�ri Lic. No. q)2Ny% Class
Contractor's Address Contractor's E-mail Address
City CaS7� /"j.tsL. State F64. Zip7?-C_? ' Telephone cigl)?90-GSoO
NO.
SETBACKS REAR SETBACKS FRONT PERMIT
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. I �
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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