HomeMy WebLinkAboutX2021-1700 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application �02 WPoRe
City of Newport Beach - Building Division o
(- Comm'[ j Residential Tom. p, Ani nWMP ( OFFS Ill IF AT TIME OF RI IRMITTAL
kBuilding F_ Grading F -Drainage F- Elec r Mech F_ Plum Cu Yd Cut Cu Yd Fill F
Project Address (Not mailing address) F_ Flood F- Fire F- Liq F_ Landslide ('-'N/A Floor Suite No
50�
Description of Work
Use [_ Const Type F
New mi w( PAP 1® � �
# Stories # Units (if ResF
1
Valuation $
New/Add SFF _.--- Remodel SF � -- Garage/New/Add F_
Material/Labor
OWNER'S NAME Last FHi (t/(V YLQ q_ xl w%Jub;1 1 t&41-$ `yeo
Owner's Address Owner's E-mail Address
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city � 6�u.1`-'a"R.. State NW Zip _ aG71, Telephone yof ^3W 'PA `
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
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City��'UMi�' D� Mfto State Zip �.ZreuJ Telephone "%��Z• �1�' r7Tul'
ARCHITECT/DESIGNER'S NAME Last il` Dift FirstDNIP Lic. No. Z/rJ{
Architect/Designer's Address Architect/Designer's E-mail Address
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city C,r S-1—AD 12sQ".. State cc : ... Zip C, i(alt Telephone c -t,15-bzo 'i
ENGINEER'S NAME Last First L---- Lic No.[ ----
Engineer's Address Engineer's E-mail Address
City State r_ Zip I Telephone) --®e
CONTRACTOR'S NAME/COMPANY a Lic -- No. FClass
Contractor's Address Contractor's E-mail Address
City State F_Zip F--�.--
SETBACKS REAR REAR SETBACKS FRONT PERMIT NO. x�Zl • 1'IDD
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. ' Q 9 . ` oz (
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $