HomeMy WebLinkAboutX2021-0709 - Permit ApplicationPunt Form Worksheet for Combo Building & Solar Permit Application o�s�
Comm'I F1dential ing Division
NOTE:. PiLAN HECK EES UE ty of Newport Beach - AT TME OF TIME
wilding r Grading
"Drainage [Elec j Mech F- Plum CuvdCut F cuvdFill s
Project Address (Not mailing address) r Flood F_ Fire r Liq j.- Landslide [_N/A Floor Suite No
Description of Work
Use ConstType $®6b{
# Stories # Units (if Res)
L®
A t_ t pW{fir �Z4 9 .9s�
Valuation
Material/Labor y-
.New/Add SF 2l Zw�
r__.� 9 I
Remodel SF I Gara a/New/Add
OWNER'S NAME
Last Wpts First
Owner's Address
Owner's E-mail Address.
7 wt
n
City /V . A41-4 S0I" R4C.0 k_ Statef -- Cid Zip 124O% f Telephone '; G�(_d7f,� .._.
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APPLICANT'S NAME -
Last First
Applicant's Address
` Applicant's E-mail Address
/0V1L-cAli/wl�� biul "tfcAtcaeo '.cw^1
.City 9 p�.,
_.. State �— Zip.._ .7 2`� Telephone 32-G-.?d`(o
ARCHITECT/DESIGNER'S NAME ' Last First F - Lic. No. —
`. Architect/Designer's Address
Architect/Designer's E-mail Address
City F_
State F--- Zip r- Telephoned-----
ENGINEER'S NAME
Last First r_ —, Lic.No.F—
Engineer's Address
Engineer's E-mail Address
24 ( C -e
i.NL ,
City ,
State .. Zip _ ���Pc{(p Telephone
CONTRACTOR'SNAME/COMPANY °k ® Lic. No. 0217-44ClassEB'd°Ccr
Contractor's Address
Contractor's E-mail Address
1103
City State —.® Z P � 2� Telephone dqDt #410- 36) 0
SETBACKS REAR
SETBACKS FRONT PERMIT NO. ' a
SETBACKS LEFT
SETBACKS RIGHT. PLAN CHECK NO. 1'
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $
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