HomeMy WebLinkAboutX2021-2586 - Permit ApplicationPrint f=orm I Worksheet for Combo Building & Solar Permit Application
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F Comm'I 'itResidential City of Newport Beach - Building Division % 1
NOTE: PLAN CHECK FEES DUE AT
TIME OF SUBMITT �/1
F -Building Grading f -Drainage r Elec F.- Mech F-; Plum Cu Yd Cut
Cu Yd Filll
Project Address (Not mailing address) F Flood f-, Fire F" Liq F_ Landslide F N/A Floor Suite No
Description of Work
b� t ConstT eF
t- n 1icl f i �� Use yP
� i Ct�'7fJe
4F Stories # Units (if Res)
i 1C-._ Gl c En Ir '7 4
New/Add SF�— Remodel SF / Valuation $ Z ix
Garage/New/Add � Material/Labor
OWNER'S NAME�j�z5
Last Firstu
Owner's Address ---
L�� Z ( OwneYs E-mail Address
city Fc ( State Zip C� Telephone
APPLICANT'S NAME Last
First
- --
Applicant's Address
Applicant's E-mail Address ,
City
State F_ Zip Telephone
ARCHITECT/DESIGNER'S NAME �(� t
Last T ZZ�i� First F P Lic. No.
ArchitecVDesigner'sAddress -= =3
r .. / Architect/Designer's E-mail Address
yl � l,&'7 �n c F/717 -71 -771 -777 --
city
/ 9
City r -
1 State Telephone 4
ENGINEER'S NAM --E` Last
j"V First __ Lic. No.�
Engineer's Address Engineers E-mail Address
City -- -
_ -
State � Zip 77� Telephone
CONTRACTOR'S NAME/COMPANY
Lic. No. Class
Contractor's Address J; Z . l 1 Contractor's E-mail Address
City State �- Zip Telephone
b �i 4y
SETBACKS REAR SETBACKS FRONT PERMIT NO. fio2) - LS�j6
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK N0. 2Z
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