HomeMy WebLinkAboutX2021-1494 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar PerAoi Loll
CKomm'I r Residential City of Newport Beach - Building Division
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL �<
Building [Grading rDrainage Elec Mech Plum Cu Yd cut F Cu Yd Fill
Project Address (Not mailing address) f' Flood r Fire F_ Liq F_ Landslide FN/A Floor Suite No
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Description of Work
Use Const T e
s Type
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# Storiesr I # Units (if Res)[—
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Remodel SF ((j-----Garage/New/AddlMaterial/LaborbC,•Uv
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Valuation $ �-
C�New/AddSFFl
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OWNER'S NAME Last
First
Owner's Address
Owner's E-mail Address
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City State -- zip Telephoner
APPLICANT'S NAME Last
First5-(.a / v�
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Applicant's Address
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Applicant's E-mail Address
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City iiwt^' aj Recl l? _.. _ State I CA �t
Zip 'nlyl� f Telephone GZV. - .��-6 •-�C,73
ARCHITECT/DESIGNER'S NAME Last
First Lic. No. �—
Architect/Designers Address
ArchitectlDesigner's E-mail Address
City r_-___---- State
Zip F -- - - Telephoner - —
ENGINEER'S NAME Last z1vul
-1-361
First Lpl l Lic. No. S
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Engineer's Address
Engineer's E-mail Address
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City d��etpe� State F A
Zip �y Telephone��
CONTRACTOR'S NAME/COMPANY Lic. No. j(j`%'� Class
Contractor's Address
Contractor's E-mail Address
City I �IGUVWF' ....LX/U' State r—
ZiP _ K, -?-q. Telephone�j2,6."c67,s--991 �.
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SETBACKS REAR SETBACKS FRONT
PERMIT NO. X�Q( — `q ( q
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. �j 13 - ` ZZ -
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $
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