HomeMy WebLinkAboutX2021-1997 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit A
F Comm I F- Residential City of Newport Beach - Building Division Application
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL U
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Project Address (Not mailing address I� Flood Floor Curd Fin
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Description Of Work
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# Stories # Units (if Res)r
New/Add SFr� ti
Remodel SFr-- Garage/New/Add �— Valuation $
Material/La r
OWNER'S NAME
Last SAS jKA
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Owners Address --
141 Owners E-mail Address
city
VS I l Vt% State �— ---
ZipI �l Telephoner-__
APPLICANT'S NAME
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ApplicantLast First 's Address : i'StiQ L L�-�
Applicants E-mail Address
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City -7-�_s, �— <`I I -f Dc� ,CSU
State Zip ry
L21 8o Telephone 2-4t _
ARCHITECT/DESIGNER'S NAME ' S
Last
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Architect/DesignersAddnFirst ss Lic. No. r---
Architect/Designer's E-mail Address -
.City
— State �— Zip r� Telephoner---
ENGINEER'S NAME
Last
--
Engineer's Address First
`. Lic.No.r�
Engineer's E-mail Address
City -
State �—
Zip
Telephone
CONTRACTORS NAME/COMPANY
Pi tgf—( 1ZVCT t D N Lc. No. Z1 b7 Class
Contractors Address
Contractor's E-mail Address
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Zip I 2,7,:FJ. Telephone�----.:: �
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SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT PERMIT NO
SETBACKS RIGHT
USE ZONE PLAN CHECK NO.
DEVELOPMENT NO
PLAN CHECK FEES $