HomeMy WebLinkAboutX2021-2524 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
mm'I F_. Residential City of Newport Beach - Building Division XUA. 2.62—q
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMI AL
[7,Building F_. Grading F -Drainage F_. Elec F _'Mech - Plum
F_
Address
o01
Flood F_- Fire r-, Liq
Cu Yd CutF Cu Yd Fill
F_ Landslide r_.N/A Floor
� F
Suite No
F_
Description of Work Use ConstType
J ewl � 4,— -tv-4,_Vc I �Vx q-)fT c.', v I,) _5,,e -c Ajo ex !Sj w,
Qw) I V J.�)toriesFT#Units(IfRes)F_
C4,v-,
. . ........
Remodel Garage/New/Add Valuation $
New/Add SFF7� Material/Labor
OWNER'S NAME Last I First
Owner's Address Owner's E-mail Address
City I ---- ----- - --- -- ----- State ZIP TelephoneF_
APPLICANT'S NAME Last
f
Applicant's Address
City State
First
Applicant's E-mail Address
------- — — -- ---------- - --------
zip F7777 TelephoneF_
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designer's Address
.. . .. . ............ .. ...... ..... - -- ----- - -
-
City State F
Architect/Designers E-mail Address
Zip F—
Telephone
ENGINEER'S NAME Last First Lic. No.F_
Engineers Address
I_- - - - - -_ ------- --
city State F
Engineer's E-mail Address
ZIP Telephone[
NAMEXOMPANYI �, Lic. No. Lr% 6� j
)V\_,1t_,_(_)_ IV16 Class
Contractdr's Address
City �iwState
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
Contractor's E-mail Address
6 -Cccl Dh b
Zip Telephone j i 9 C C>
1437
PERMIT NO.
PLAN CHECK NO, 14LIW 0 02
PI AN r.HP:r.K PFPRR