HomeMy WebLinkAboutX2021-2755 - Permit ApplicationPint Form Worksheet for Combo Building & Solar Permit Application
City of Newport Beach- Building Division X 22
Comm'I r Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL��
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Project Address (Not mailing address) C Flood F_ Fire F- Liq F,,- Landslide FN/A Floor Suite No
Description of Work
Use F_ Const Type
# Stories # Units (if Res)F
New/AddSFF77777 Remodel SFF— Garage/New/AddF—
Valuation $ }'
Material/Cabo
OWNER'S NAME Lastl �oCyp q t first
Owner's Address Owner's E-mail Address
City State zip Telephone
APPLICANT'S NAME Last :YU'7.... First /
Applicant's Address Applicant's E-mail Address
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City �Z oL State [Q Zip �� Telephone
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ARCHITECT/DESIGNER'S NAME Last First —'' Lic. No.
Architect/Designers Address ArchitecUDesignees E-mail Address
City F State �- Zip F Telephoner
ENGINEER'S NAME LastFirst bLic. Nof -72_
Engineer's Address Engineers E-mail Address
City i State I Zip o�5_0' Telephone �0 ,;;�,Z� �
CONTRACTOR'S NAME/COMPANY Zol Lic. No. Class
Contractor's Address Contractor's E-mail Address
City � nil /j StateF-e Zip 9 Telephone `r/ 5 / 4W% C?
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SETBACKS REAR SETBACKS FRONT PERMIT NO. Z-75
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. Z�-
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $