HomeMy WebLinkAboutE2021-0681 - Permit Applicatione;r'U
_ - Print Form Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division
j� Comm'I (� Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address Not mailing address f q F
9 Flood Fire ( Li Landslide �N/A�H'ite
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Description of Work uIS kti'. �"`� �►a1�1 Ana L`,9� S��� �°;` (f
Use F Const Type
# Stories #Units (if Res)
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CW I t 100\A15 S I P t N YjQ 0`Zr_ ' 1 �'`! 1155�5
Valuation $ k
New/Add SF�� Remodel SF� Garage/New/Add
Material/Labor
OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
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City l i'LYI i—! C _. _.._ .. State C Zip 2E U(p._....... Telephone`. ...... _4�_ _ _''
APPLICANT'S NAME Last a e,�,,Wmk L-1Pt1 icI'I'`��- First �W '1) 015 6..�--1
Applicant's Address I Applicant's E-mail Address
City 1 �� 1 State I Zip ` b (,P Telephone
ARCHITECT/DESIGNER'S NAME Last First > t !� G 17 g�
�.r-�ZGC� � /�- Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
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City A-r 4v+ �j �/( State ®�®0 Zip �� Telephone
ENGINEER'S NAME Last x First Lic. No.
Engineer's Address Engineer's E-mail Address
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City State Zip F® Telephone
CONTRACTOR'S NAME/COMPANY Lic. No. r Class F
Contractor's Address Contractor's E-mail Address
City F_State Zip Telephone
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SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. Z&1q G " Z 7j
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $