HomeMy WebLinkAboutX2021-2470 - Permit ApplicationXZo21-2uW
Print Form Worksheet for Combo Building & Solar Permit Application 041-R
F- Comm'I F_ Residential City of Newport Beach - Building Division /'
--`NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL (�
Building r Gradingrainage r Elec r- Mech �, Plum Cu Yd Cut F_Cu Yd Fill F
Project Address (No g address) Flood j Fire ndslideN/A Floor Suite No
Description of Work
Use F—Const Type F_
# Stories # Units (if Res)l
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Valuation $ / Q
Material/Labor
New/Add SF,2 S Garage/New/Add F /JO LS
OWNER'S NAME Last First r�7
Owner's Address Owner's E-mail Address
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City -e4 �� State I �/ Zip 7Z -(v63 Telephone4 °9c/
APPLICANT'S NAME Last % / First
Applicant's Address Applicant's E-mail Address
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City
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ARCHITECT/DESIGNER'S NAME Imo'
Last 015 a-` ' First I �y,� Li Lic No.
Architect/Designers Address Architect/ E-mail
/Designer's nAddress
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City . co a t. State Zip `�2� Telephone- ,/`/-5/e
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ENGINEER'S NAME Last L✓/ Firstd ---' Lic NoF
Engineer's Address Engineer's E-mail Address
Year C i 9�-
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City - jG�n ✓Ln C State F '(�-- Zip q/ Telephone y'yC/ yzj`L/.__ YL'yj
CONTRACTOR'S NAME/COMPANY { Lic. No. �— ClassF_
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Contractor's Address Contractor's E-mail Addresss
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City `lyy.3.-�
N 4 State C Zip f�-z- Telephone
SETBACKS REAR SETBACKS FRONT RID PERMIT NO. Xa1Qi (-
SETBACKS LEFT SETBACKS RIGHT] PLAN CHECK NO. 1 l
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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