HomeMy WebLinkAboutX2021-1235 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application slt
r Comm'I Residential City of Newport Beach - Building Division Y,2-02-1NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL LI I J 2 r W r r a1v
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Project Address (Not mailing address) I `klood F` Fir iq Landslide [_N/A Floor Suite No
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Description of Work
Use Fv_� Const Type
# StoriesX # Units (if Res)F
.Valuation
Material/Labor 110i'
New/AddSFF
� --- RemodelSFrGarage/New/Add
OWNER'S NAME Last r— --i ' First
Owner's Address
Owner's E-mail Address
City
State f Zlp F— Telephone---_
APPLICANT'S NAME
Last first
Applicant's Address
Applicant's E-mail Address
City I
State �,- .Zip F_-_____ Telephone—_..--
ARCHITECT/DESIGNER'S NAME
�_ LIC. No. f.._._.---_
Last °}y�First _—__-_
Architect/Designer's Address
Architect/Designer's E-mail Address
City 'State --- Zip 1� Telephone
ENGINEER'S NAME
Last 1 `LD FirstMWi_ Lic. No. $ fe�
Engineer's Address
Engineer's E-mail Address
City
State r--- Zip f ---- — Telephone[ -7,
CONTRACTOR'S NAME/COMPANY $444 a�n5� hLic.No.qa$GZ Class
Contractor's Address
Contractor's E-mail Address
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City 5(�v(.a - /I
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®- Zip a2'1rp cf Telephone Orli 54q,"t.{aq { -
State r.
SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $