HomeMy WebLinkAboutM2021-0068 - Permit ApplicationPrml'Form ] Worksheeffor'Combo Building & Solar Per- it It �r/I
F,, comm" f7Residential City of Newport Beach - Building Division Tn I_� � D
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
[-.'Building Grading EDrainage ❑Elec F-,Mech
r, Plum cuydcut[77
Cu yd Fill
Project Address (Not mailing address) rl Flood
❑ Fire r Liq I- Landslide
❑N/A Floor
Suite No
New/Add SF J, Remodel SF Garage/New/Add
Use F ConstType
# Stories[— # Units (if Res)
Valuation $
Material/Labor Z'o. �UC-)
OWNER'S NAME
Last e��--_ - _ First -- -J74- ---------_
Owner's Address Owner's E-mail Address
Ile
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City i O �t State -
Zip 7 Telephone
- - - — I ` -` `�-
APPLICANT'S NAME Last I First
Address
City State
ARCHITECT/DESIGNER'S NAME Last
Architect/Designer's Address
City State
Applicant's E-mail Address
Zip �— Telephone[
First �— Lic. No.
Architect/Designees E-mail Address
Zip F— Telephoned
ENGINEER'S NAME Last �et( t -pt/ First [ -75 (Q(� Lic. No.�
Engineer's Address n Cooff- $"l 61 �.._a-`3 t � S LJ - --- -.
CityLZq V ��qu� 1 State
Engineer's E-mail Address
------_-_-------
Zip - C� ?� Telephone[
CONTRACTOR'S NAME/COMPANY ��e �luu u`C Lic. No. 5dpL_kt3YClassF
Contractor's Address
City State �.
SETBACKS REAR
SETBACKS LEFT
Contractor's E-mail Address
See Lltl, lc _*¢ (( tr"p
Zip Telephone C��(a1 5�57fs
SETBACKS.FRONT PERMIT NO.
SETBACKS RIGHT PLAN CHECK NO.
ZONE
DEVELOPMENT NO
PLAN CHECK FEES $