HomeMy WebLinkAboutX2021-0260 - Permit Application� ZX'M . U //kv U
Worksheet for Combo Building & Solar Permit Application
7 Comm'l r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding r' Grading F -Drainage F-Elec rMech Plum CuvdCut F--
Cu Yd Fill
Project Address (Not mailing address) r Flood r Fire r Li I
_ q i- Landslide rN/A Floor Suite No
New/Add SFF Remodel SF lr-
Use F— ConstType F—
# StoriesF2—. Units (if Res)F—
Garage/New/Add F— Valuation $
Material/Labor I �. I �40 o
Ll�
Last
(sOtj%-AL�,t.Z, First
/rOwner's E-mail Address
State
_ . .. I C/j."r... ZIP I C?Q ?'? Tele
APPLICANTS NAME
Last I _ 3 rA
Applicants Address
� �3 4 � G Af✓4 o�v �=-�-
City . � (, A/ IA _ ... State
ARCHITECT/DESIGNER'S NAME
Last
Architect/Designer's Address
City State �—
ENGINEER'S NAME Last I
Engineer's Address
City
First 1 11 P./ cruS
Applicant's E-mail Address
ZIP ��,�' Telephone7/4�a
First F� Lic. No. �--
Architect/Designer's E-mail Address
ZIP F— TelephoneF�
First( I 6— Lic. No. r�s
Engineer's E-mail Address
ZIP�vSTelephone) io.��v
CONTRACTOR'S NAME/COMPANY Vl CL JS tom! �0�� tr— �--
J Lic. No. � f /. (� Class
Contractor's Address 44
N Contractor's E-mail Address
RvGt2&!�o% nt D Gox .
City IF.Wi�� -RA/A- State �- Telephone7 f 4 S3 9 11,3f
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEES $ _y_