HomeMy WebLinkAboutX2021-1728 - Permit ApplicationPe! nit Print Form Worksheet for Combo Building & Solar Pe It p`plica i ��E"" R
F Comm'I esidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL c.'oa�'
wilding [Grading
F_,Drainage I�'Elec rMech r"Plum Cu Yd cutF Cu Yd Fill
Project Address (Not mailing address) F_ Flood [-= Fire 7- Liq F_ Landslide [N/A Floor Suite No
De lon of Work
Use Const T e
vp V'B
2 ,
i IF Stories # Units (if Res)
SF F
_ W_ Woo AAA hk_ Valuation $
4New/Add
Remod SF Garage/New/Add Material/Labor
OWNER'S NAME
Last C �S sl) _..._... First _ _...
Owner's Address
Owner's E-mail Address
City _..
_ ....State —._ Zip F Telephone
APPLICANT'S NAME
Last %CL�G�..... First at- c dM/
t
Applicant's Address
Applicant's E-mail Add r ss
Z7/__3 __
e -Kae � e5'yR 9,02?f C'O�
City .. / ...
45-f _ State �v-v- ZipTelephone gCfF.�LC
/
ARCHITECT/DESIGNER'S NAME Last ��/�� First Lit. No. _
Architect/Designer's Address
Architect/Designees E-mail Address
City _..
_. State r--..----. Zip (— Telephonef-
ENGINEER'S NAME
Last FirstI. - Lic. No.�
Engineer's Address
Engineer's E-mail Address
City
StateF Zip F Telephoner
CONTRACTOR'S NAME/COMPANY Lic No. F Class F
Contractor's Address
Contractor's E-mail Address
City _
',. State �— Zip �� Telephoner_--._...-_.....
SETBACKS REAR Sj
SETBACKS FRONT I� / PERMIT NO. �� • I� `�
SETBACKS LEFTL
SETBACKS RIGHT PLAN CHECK NO. �SIIo.Zd2d
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
I I -I - 10 15