HomeMy WebLinkAboutX2021-3154 - Permit ApplicationElliot corm Worksheet for Combo Building & Solar Permit Application
Comm'I r Residential City of Newport Beach Building Division X U % i - �I i O=1
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building F_ Grading Drainage F_Elec rMech F-, Plum CuvdCut ( CuYdFinl-
Project Address (Not mailing address) C Flood C Fire [ Liq (- Landslide CN/A Floor Suite No
Description of Work Use F Const Type
QY&J A IL
# Stories #Units (if Res)
- Valuation $
New/Add SF7— Remodel SF�- Garage/New/Add �— Material/Labor
OWNERSNAME Last A-CcOCYZ11`j}`1
Owner's Address Owner's E-mail Address
_ State C/4- Zi Telephone - f q f -735 - 3.77
city[ 3 _- _ P -_%hQ. -
APPLICANT'S NAME Last
S/)wl_i /i� dUhlirEle
First
Applicant's Address
Applicant's E-mail Address
City
State
Zip �— Telephoner
ARCHITECT/DESIGNER'S NAME
Last F77777777
First �- Lic. No. F7777—
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State �—
ZIP �— Telephoner
First F Lic. No.F
ENGINEER'S NAME Last
Engineer's Address
Engineer's E-mail Address
_
City
State
_
.Zip F_ Telephoner
r
CONTRACTOR'S NAME/COMPANY UGk y C[�
Lic. No. Class !3 C�
rtls7(ZGJ�/« 9L{ -
Contractor's Address
Contractor's E-mail Address
City �iC%Y1 Z�✓
State �/
Zip G2�v) Telephonef cL) c�'� S JV Ll
SETBACKS REAR
SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $