HomeMy WebLinkAboutX2021-0190 - Permit Applicationj Print Form Worksheet for Combo Building & Solar Permit Application
Comm'I j—; Residential City of Newport Beach - Building Division A�a�u
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Building [I Grading rjDrainage [i Elec F Mech f7 Plum Cu Yd CutF_Cu Yd Fill �
Project Address (Not mai1ling address) ❑ Flood i—i Fire i—i Liq j—; Landslide ❑N/A Floor Suite No
I$Ov�POGt— Qlucl, —01- 7 F77
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Description of Work
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Use I I Const TypeF__7
# StoriesF # Units (if Res)n
Valuation
New/Add SF Remodel SF J Garage/New/Add J Material/Labor
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OWNER'S NAME Last I Pi /jet
First
Owner's Address Owner's E-mail Address
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City F1i%/t _ ,M(A6 0- l State ! ` I Zip Telephone
APPLICANT'S NAME
Last Uu _I I First I h4v2ai . LiuCslvtao��'I�t�kw�u�. �-ow�
Applicant's Address Applicant's E-mail Address
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City N (�� - F� 0.0 I State C�..... Zip Fci-�Q �PO Telephone o) `f) `Y2, - 05l��
ARCHITECT/DESIGNER'S NAME Last First F-1 Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State F Zip FI Telephoned
ENGINEER'S NAME Last First Lic. No. -1&O1S
Engineer's Address Engineer's E-mail Address
City iiU\VkQ. _ State Zip C �-�0 i4 Telephone
CONTRACTOR'S NAME/COMPANY Lic. No. elegielk Class
Contractor's Address G Contractor's E-mail Address
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city � State Fan Zip etzirJ I Telephone 95/ ���/ 94,
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SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT
SETBACKS RIGHT
PERMIT NO.
PLAN CHECK NO. %a-.^ ca i
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $