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HomeMy WebLinkAboutX2021-2783 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application City of Newport Beach - Building Division o _ r Comm'[ r Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL rBuilding [Grading F -Drainage r-Elec rMech F- Plum CuvdcutF__ CuvdFill I Project Address (Not mailing address) F7 Flood r Fire r Liq F_ Landslide CN/A Floor Suite No ( I Description of Work Use F_ Const Type # Stories # Units (if Res)F_ / Q tv Valuation $ aQi7 gg �t c' 7— Material/Labor 0, New/Add SF�— RemodelSF[— Garage/New/Add— OWNER'S NAME Last i-rAm^n/kA(Atj First V RUt� Owner's E-mail Address Owner's Add,�.rre�ss'� 1 ^' I I L.1AN V^� � � L City _ State ( Zip Cl5�6 c Telephone 4 � -7 APPLICANT'S NAME Last 1 ti ( i �4- First "' .Lj!s, Applicant's Address Applicant's E-mail Address Leof X. q�Cl ZiP q, `j„ �l ©� Telephone �. �j. 1 3 6 J T7 Z.. O City _� �S-tat—e - ARCHITECT/DESIGNER'S NAME Last I First F— Lic. No. 7— Architect/Designees Address Architect/Designer's E-mail Address ..-_._. .- _....____.... _.. _........._- City State �— Zip F— Telephone[ ENGINEER'S NAME Last X r�— R D First Q I rA N6- Lic. No. f `,Z Q q Engineer's Address Engineer's E-mail Address iSrr7--C--C��fzD0�6it7LL®W; i �t� n State F ZIP I (� S Telephone[5 I L1- - 6' 0 S -10 city j n /� 9. � , CONITRACT�OnR'SVNAAMEICtOMPA`NY ��r�� 4 p��� Lic. No. `j3`1(t(i0classi�— Contractors Address Contractor's E-mail Address l`i 4CL <fAVLIotNJ i — 3� City �,4. state �Zip ( Telephone 94-`� 7�n SETBACKS REAR SETBACKS FRONT SETBACKS LEFT- SETBACKS RIGHT PERMIT NO. X PLAN CHECK NO. USE ZONE DEVELOPMENT NO PLAN CHECK FEES $