HomeMy WebLinkAboutX2021-2677 - Permit Application1= nt Form._j Worksheet for Combo Building & Solar Permit Application
r Comm'I I— Residential City of Newport Beach - Building Division •2 LU I 1
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL c�
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_ ,Building F_ Grading F`iDrainage _ Elec ; Mech F✓PIum cu Yd cut ' Cu Yd Film
Project Address (Not mailing address) F-, Flood f7 Fire F_ Liq r Landslide rN/A Floor Suite No
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Description of Work
Use Const Type
,£ftories[ # Units (if Res)-
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New/Add SF !
Remodel SF 1. p
Valuation 5
Gara a/New/Add �I Material/Labor
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OWNER'S NAME Last
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First
Owner's Address
Owner's E-mail Address
City b State Zip Telephone G
APPLICANT'S/NAME Last�J
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First�t%f��G—
Applicant's Address
Applicant's E-mail Address
City � �� State F—
Zip 5vD ,2_ Telephone 7f�•7�G� Q X0
ARCHITECT/DESIGNER'S NAME Last
First F Lic. No. K/Z-191i
Architect/Designer's Address
Architect/Designer's E-mail Address
City State
Zip �— Telephoned
ENGINEER'S NAME Last
First f T C�PIIi� Lic. No.
Engineer's Address
Engineer's E-mail Address
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City State
Zip q/�je) Telephone 6j6�� p d70
CONTRACTOR'S NAME/COMPANY �c i �awi
Con y}/n L� i Corn n cLic. No. q5 S� Classy
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Contractor's Address
Contractor's E-mail Address
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City 5Z,� An C, State CA
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SETBACKS REAR SETBACKS FRONT
PERMIT NO. VZO-t� (— 7-1-77
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $