HomeMy WebLinkAbout2761-2021 - Permit Application-Print Form Worksheet for Combo Building & Solar Permit Ap Iiica itlon 9
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F- . Comm'I .--- Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITALI? n I � 14
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F. -,Building F- Grading -,Drainage F- Elec [7 Mech rPlum Cu Yd Cut Cu Yd Fill
F
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Project Address (Not mailing address) r- Flood Fire f-, Liq Landslide F-.�N/A Floor Suite No
F77
Description of Work UseConstType
F
# Storlef 7 # Units (if Res)F
Valuation $
New/Add SFF --- Remodel SFF —104,L Garage/New/Add -- Material/Labor
--- -- -- 1
OWNER'S NAME Last[_ First
Owner's Address Owners E-mail Address
t � - --:5, -- - - -- - -- -- - -- - -- ------
------ - -- - - -- - ---
City D&L State F—C41 zip Telephone
[91
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APPLICANT'S NAME Last I (>C -
Applicant's Address
. ........ .. 4t7i ..-
City F4 A.1 State C4
First
Applicant's E-mail Address
Zip I i Z�r7 - - - - -------- --
Telephone 77!F�--IS-8 2—
ARCHITECT/DESIGNER'S NAME Last First FF—,(J-ryt,15 Lic. No. F—
Architect/Designer's Address
... .......
City State
Architect/Designers E-mail Address
- -------- --
zip 9 Telephone
ENGINEER'S NAME Last First---s-s-
�— Lic. NoF 3s
Engineers Address
CitygJ State F
CONTRACTOR'S NAME/COMPANY
Engineer's E-mail Address
I,---- -,'", - --- --- - -- -------
. ---- - - -- - -- - - -- -- -
7— ZpF7Te6ZV Telephone - 57�7 - 331
Contractor's Address
Zoo d9AAj6(5 (.)tdvC 4,,R -
city c �,�j State Zip
SETBACKS FRONT
SETBACKS RIGHT
USE ZONk - / - DEVELOPMENT NO
oltTL 6, 1W i L
711613314-2?S�4,9
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEES $