HomeMy WebLinkAboutX2021-1419 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application o���W�°Rm
�sidential City of Newport Beach - Building Division X a0;L h ��
Comm" ►i'►�e NnTF• PLAN CHECK FEES DUE AT TIME OF SUBMITTAL '�-F�aN'
F-BuildingF Grading f--'"Drainage F Elec F- Mech
Plum Cu Yd Cut Cu Yd Fill F
Project Address (Not mailing address) f— Flood
F- Fire [— Liq F- Landslide F-N/A Floor Suite No
�....
� L 1 O c� P� C✓ I� r' t
1710 H TK
Description of Work
Use Const Type
# Stories[ # Units (if Res)
Q FP- ��� [,(_ 9j CCU ('/kLL� L C'�)
PF J T 1—/k N� —,2'CAPEF
Valuation $
Material/Labor '� (goo
New/Add SFF Remodel SFF__ _ _ Garage/New/Add
OWNER'S NAME Last G
First 0 `.`\JA t1
Owner's Address
Owner's E-mail Address
City U 5 -r I State
Zip pl �7�jv Telephone.- Y —
APPLICANT'S NAME Last —L��\�
First
Applicant's Address
Applicant's E-mail Address
City L v�v--i ,� State ,
n�iV.l
Zip L 27 L7 TelephoneF4�. - -_P
ARCHITECT/DESIGNER'S NAME Last L c First F Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City L.........� State
Zip f Telephone
ENGINEER'S NAME Last N� A
First Lic. No.�v
Engineer's Address
Engineer's E-mail Address
City State
Zip r Telephone
CONTRACTOR'S NAME/COMPANY PI—ITZZ. CC?LQ75 KL)C,TCDP� Lic. No. F�,7-4�Class�
Contractor's Address
Contractor's E-mail Address
V2 51T .
15 (o C,0l\�s- ROc-rl00 , �vt-ot
City �(-v State , 7
v J71� I Lt�
Zip q 2-7ev Telephone 7 14 -
`L
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
f
del PLAN CHECK FEES $
2.3,)r - ZED