HomeMy WebLinkAboutX2021-2604 - Permit Application (2)�; AnntForm .� Worksheet for Combo Building & Solar Permit Application @54,�O�
F- Comm'I Residential City of Newport Beach -Building Division �Zp�-ON
K Li - Zl SYJ NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding rGrading Drainage rElec FMech F_ Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) F_ Flood r Fire F_ Liq Landslide r_N/A Floor Suite No
Description of Work
Use F—Const Type F
GL
_i1l'.cV `Jn'L� C4�_�lti-c.C.,F� � \ � ��C�t�_�Qa't(.cS•
# Stories # Units (if Res)[T
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- ,�
New/Add SF � Remodel SF Garage/New/Add �
Valuation $ F�z
Material/Labor
OWNER'S NAME Last First S&w
Owner's (Address Owner's E-mail Address
City C tie � State ZipTelephone r
Y
APPLICANT'S NAME Last rst
Applicant's AddressApplicant's E-mail Address
City State F Zip F— Telephoned
ARCHITECT/DESIGNER'S NAME Last�
G �r First #W�`� Lic.No. (U_
Architect/Designees Address Architect/Designer's E-mail Address
o )_ _ _ _ eCC ra s ��� e :L
City State F CT_Zip Telephone
lJ�—
ENGINEER'S NAME Last First Linc.. No.
Engineer's Address Engineer's E-mail Address
City State Zip Telephone
CONTRACTOR'S NAME/COMPANY Lic. No. �— Class
w L factor's
Confractor's Address Vv� 1+ E-mail Address
City State F Zip F Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK N0. Z/L bb
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $