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HomeMy WebLinkAboutX2021-0267 - Permit Application (3)Print Form Worksheet for Combo Building & Solar Permit Application F_ Comm'I r Residential City of Newport Beach - Building Division NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITT L rBuilding F_ Grading rDrainage F_Elec f—Mach r Plum Cu vdcutF Cu Yd Fill F Project Address (Not mailing address) f—, Flood j— Fire r Liq f Landslide rN/A Floor Suite No Description of Work Use ConstType An L) A I> t) i TI D IBJ # Stories # Units (if Res)s Valuation$ Material/Labor New/Add SFF- Remodel SF F Gara a/New/Add F_ _ g - OWNER'S NAME Last [��� PK/\_t~ C First �t Owner's Address Owner's E-mail Address P`ES . �,i. _ r (Ja t_t, City TiJS`C'I S State I tom' Zip �790 Telephone 'S.. L I t I APPLICANT'S NAME Last First Applicant's Address Applicant's E-mail Address �a a rvc�cc b4C2 rs-ra �t'�HCL cam( City 7i1)3TLI� State ___ — Zip La7�i� TelephoneF9`�L'��J'�b-. ARCHITECT/DESIGNER'S NAME Last rmr— e1L First Lp Lic.No. '�- Architect/Designer's Address Architect/Designers E-mail Address AA p) AI T1 o4 C° MStJ ' C©g"j City �_�State IL+Q' Zip F— Telephone 7 (4 _03t;- 1 ENGINEER'S NAME Last 1A- .-- 14 b First jar t Lic. Engineer's Address Engineer's E-mail Address C_1P l�hlgjl� / tl� `AJA0IRA=Tti"[S�J L) t11 city ��- State, _ Zip Fa Telephone 7th _ 634S —(,-qZO CONTRACTOR'SNAME/COMPANYLic: No. 71b7 -f ClassF pM"� C'L�� z(�-L)c-rcov� Contractor's Address Contractor's E-mail Address City To 5— C W State CA , Zip [�� 7 gv Telephone 7j`� — 7 S� — `� III SETBACKS REAR SETBACKS FRONT PERMIT NO. SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. USE ZONE DEVELOPMENT NO PLAN CHECK FEES $