HomeMy WebLinkAboutX2021-1307 - Permit Applicationcomm'I
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Worksheet for Combo Building & Solar Permit,'ApPlication City of Newport Beach - Building Division
ResidentialNOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
r Grading rDrainage r Elec r Mech r Plum cu Yd cut
Cu Yd Fill
Flood Fire r Liq LandshdeG� f NFloor Suite No
Address (Not mailing address) f
of Work
nn�Ui•
`-
New/Add SFF--
OWNER'S NAME
Owner's Address
City ni -'
Remodel SFV
APPLICANT'S NAME Lai
Applicant's Address
City
ARCHITECT/DESIGNER'S NAME
A. i7
Use �'
/ ..x'c1. i7. c IV 011
T") i yr `d
r,, vcr�.a:. f`,ce<c ��rvc.,yF #Stori
✓pro �t3/a•,.v�;
aluation $
Garage/New/Add Material/1-AG
Material/Laya Ix
First I thl A Lam" _
, Owner's E-mail Address
62q Q.
ate �'=? i Zip Telephoned tj --
State F Zip
Last I [ A f2, -W 4 k t
Architect/Designer's Address
111601 1?A Si". re I z7 a
City G v5 , I N State C�
First j tN R; L.'P"
Applicant's E-mail Address
Telephoner—�
(if
First i�e-r1tg Lic.No. C11
Architect/Designer's E-mail Address
IAI.,
,J j r„
Zip Z C' Telephone C:I c y .'� "`f
i
ENGINEER'S NAME Last F�\a� 1 �� First
Engineer's Address ' ` _ v Engineer's E-mail Address
<aa
LIC. NO. C���,p3oEq
City
State r—. -Zip r----- Telephone f ----
Lic. No. r--- class
CONTRACTOR'S NAME/COMPANY
Contractor's E-mail Address
Contractor's Address
City � t�
State F_ZiP r --0---_v- Telephone I �/�I-()
SETBACKS REAR
SETBACKS FRONT PERMIT NO.
ET BACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
PLAN CHECK FEES $
\; 7nniF DEVELOPMENT NO
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