HomeMy WebLinkAboutX2021-2940 - Permit ApplicationPint Form
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Worksheet for Combo Building & Solar Permit Application
Residential City of Newport Beach - Building Division �V . LA
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Building Grading Drainage (-Flet r-MechPlum Cu YdCut F Cu Yd Fill
Project Address (Not mailing address) F_ Flood r Fire r Liq r Landslide FN/A Floor Suite No
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Description of Work CJ.rl.�c,,_u sZ
Use F Const Type
# 5tories1_ # U nits (if Res)
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New/Add SF F_Remodel SF�— Garage/New/Add Ir
Valuation
Material/Laa bor
OWNER'S NAME Last El l lr ��� First
Owner's Address Owner's E-mail Address
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CitySoGh State Zip "1 Telephone ytq (PG 7-Sy��
APPLICANT'S NAME Last Firsty C[
Applicant's Address Applicant's E-mail Address-
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City � State CA- Zip q 17la2 Telephone pq S/05 �,S&
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A /DESIGNER'S NAME a
Last ; � First .. Lic. No.
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Architect/Designer's Address Architect/Designer's E-mail Address
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city State - Zip Telephoner
ENGINEER'S NAME Last First Lic. No.—
Engineer's Address Engineer's E-mail Address
City State Zip Telephoner
CONTRACTOR'S NAME/COMPANY 1 Lic. No. Class 0
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Contractor's Address Contractor's E-mail Address
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City I QPVr1.W,,A State 1A Zip �I-?(p�5- Telephone -To', $bS-S15/o/
SETBACKS REAR SETBACKS FRONT PERMIT NO.6
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $