HomeMy WebLinkAboutX2021-2115 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application o?EW°°Rm
City of Newport Beach - Building Division
21,r2115 a
� Comm'I FX_ Residential
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMI
r•Building r Grading F;Drainage rX Elec FX_ Mech
FxPlum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) rFlood FX_ Fire FX_ FX_, Landslide rX_N/A Floor Suite No
F_
W,C- \\ `
Description of Work
Use F_ Const Type F_
#Stories #Units (if Res)
S
Valuation $
New/Add SF�— Remodel SFF _-- Garage/New/Add �'
Material/Labor
OWNER'S NAME Last First `JAL1 -76c)
Owner's Address
Owner's E-mail Address
i 'u>o OL ��2 _ _
Aa \.,C- e,,1 N1,=,h cNw�
City j_cGG�_ State F,
Zip q Telephone if -)' - � - y
APPLICANT'S NAME Last 1 u G' First F
Applicant's Address
Applicant's E-mail Address
1�ceS 2M�((� t •GJn
q
23 `� T -d �14NJIG ��. Dru %2(,2i
City State I - ' `
Zip q Zbc-.5- Telephone_,0 3'3 -0 30 Cj
ARCHITECT/DESIGNER'S NAME Last � G I ,
First \ J A V , Lic. No. C�
Architect/Designer's Address
Architect/Designer's E-mail Address
CityState �Gt�
Zip �T S Telephone Com(
ENGINEER'S NAME Last
First Lic. No.F_
Engineer's Address
Engineer's E-mail Address
City State
Zip r-- Telephone
CONTRACTOR'S NAME/COMPANY / I� N �� �e c. No. lass
Contractor's Address
Contractor's E-mail Address
City G N State !i\-
Zip Flo 6t, Telephone lIcq') (� G'3w
SETBACKS REAR SETBACKS FRONT
PERMIT NO. Y-(_/7/` — C� S
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $