HomeMy WebLinkAboutX2021-1327 - Permit ApplicationPrint Form
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Worksheet for Combo Building & Solar Permit Application
Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITT o
Building Grading Drainage [_ Elec j Mech I' Plum Cu vd Cut t Cu Yd Fill
Project Address (Not mailing address) Flood Fire Liq j— Landslide /A Floor Suite No
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Description of Work
Use F_ Const Type
# Stories[— # Units (if Res)
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valuation $
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lev /Add SF 1 /�( �' el SF �- ara evy/Add o,S
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Material/Labor
OWNER'S NAME Last raj C First \�)Q(� \/
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Owner's Address Owner's E-mail Address
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City ('60fo \-:)c` N\w/ State Zip Telephone)
APPLICANT'S NAME Last �\ U�ytrt? ct U First C
Applicant's Address Applicant's E-mail Address
Z5U New,'ofV C-enker o30S (`cJ'\`) @\eAbulnf-QU -G-lCy kt-eCIO re .<<
City I Newec}f* 6eacV1 State C Zip qZ�o(ou Telephone C LACA (0'73 -- 3`6_,q
ARCHITECT/DESIGNER'S NAME Last ���ISV C eQ lJ First C �� �`_� Lic. No. C,3C}C>��
Architect/Designer's Address Architect/Designer's E-mail Address
Z SU Ne\,tj en+tx`o(- -t�3c)S �h� t5 a. 1 e+ourf a3 fectore . co
City e.W PU i k 1;6CC+l C \,(1 State (7� Zip qZ (D Ca O Telephone)) q G rl 3 • 3 Z53 y
ENGINEER'S NAME Last wOt �� G (,e First 5C.0 W k __ Lic. No.
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E-mail Address I 3
Engineer's Address Engineer's
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City I LQIye State Zip`
��5� ,Lp 0 Telephonel
• CONTRACTOR'S NAME/COMPANY �i�SCr C VStU v-\ 4 ox,, \ e 5 Lic. No. F Class
Contractor's Address Contractor's E-mail Address
City State F Zip F Telephoned
ACKS EAR j r'� ti SETBACKS FRONT �S "'6 PERMIT NO.
< SETBACKS RIGHT r—b PLAN CHECK NO.._. /'ICU 2,1
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U Z I DEVELOPMENT NO a PI N CHECK FEES $