HomeMy WebLinkAboutX2021-1511 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application o?�
r- Comm'I F_ Residential City of Newport Beach -Building Divisionx�Z ( I� I 1 o
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL 5.�.�a�'
W.Building F Grading F -Drainage Y_Elec j-Mech r Plum cuvdCut F CuvdFill
Project Address (Not mailing address) F_ Flood r Fire F, Liq r Landslide 1 -N/A Floor Suite No
Description of Work TO MOpEL, IPA) F- EX -T'&
Use $ Const Type
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,BUD New MAMF ��4T,�p—WA- �y( f {AlLG✓,4ti1 !�
# Stories # Units (if Res)FT
`j7J i/P(7'�tT GGl�31NETS
,44CE55 $A'1%iMS.
Valuation
Material/Labor ` �U
New/Add SF�- Remodel SFF���gr�', Garage/New/Add
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OWNER'S NAME Last �RS First
Owner's Address Owner's E-mail Address
City /._ '. (% • __... '.. State F�- Zip I _b Telephone _ -9q
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
City �- State F_ Zip F_TelephoneF_
ARCHITECT/DESIGNER'S NAME Last D,R"v First q-*AlLic. No.
Architect/Designer's Address Architect/Designers EE Address
--mail
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City Al- V 1 N _ State Zip /� , Telephone 7/ Q "�/.�
ENGINEER'S NAME Last )R j First F Lic. No.
Engineeif r's Addressr Engin er' E-mail Address,
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City. -• _. State � Zip � . - Telephone _. � / ;33
CONTRACTOR'S NAME/COMPANY Lic. No. F_ Class F_
Contractor's Address Contractor's E-mail Address
City I State F_ Zip Telephoned—.
SETBACKS REAR SETBACKS FRONT PERMIT NO. XZ02E
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO, jJ '', ZOZ-A
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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