HomeMy WebLinkAboutS2021-0172 - Permit Application (2)Print Form ] Worksheet for Combo Building & Solar Permit kp idatTdr� ;4_a R
f/ Comm'I F _ Residential City of Newport Beach - Building Division r
N NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL f -C oa J
F -'Building F_ Grading rDrainage rElec rMech r- Plum CuvdCut- CuYdF
Project Address (Not mailing address) r Flood r Fire r Liq r Landslide rN/A Floor Suite No
�5 F_
ll �g__
w 3
Description of Work
Use F—Const Type F_
#Stories units (if Res)
f3�ifi c I R, ewt) ya
1/7 A a o,- de2wa - v1111g ,-202 `%
G
j_ -_.- -..._ _.
'#
Cot)New/Add
Material/Labor /
—_--- FValuation
SF Remodel SF 2ga/New
OWNER'S NAME Last 1,4--75-1
C oZ Sod )vy a&lrst
Owner's Address
-0-I ""f ,44/ Z0 Owner's E-mail Address
City L�t!! �'0�/ _�CCCGt
State Zip 11 6.3 Telephone � C/" t/o�O� 7200
APPLICANT'S NAME Last
�75�_ GQ F/G� [ L First
Applicant's Address 2-bol&PAa-/
Applicant's E-mail Address
City , /�y01f 13-e�(1
State �G17
Zip 26� TelephoneFl G (f�- 200
i
ARCHITECT/DESIGNER'S NAME
Last First F Lic. No. F_
Architect/Designer's Address
Architect/Designer's E-mail Address
City
. -----------
State F Zip r-----.--- Telephone
ENGINEER'S NAME Last
First Lic. No.F _''
Engineer's Address
Engineer's E-mail Address
City
State F Zip--, Telephoner
CONTRACTOR'S NAME/COMPANY
Lic. No.F � Class
Contractor's Address
Contractor's E-mail Address
City
State F Zip F Telephone
SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $