HomeMy WebLinkAboutX2021-2481 - Permit Applicationeel �n
Print Form Worksheet for Combo Building & Solar Permit Application
Comm'I j— Residential City of Newport Beach - Building Division �i �O- ��
NOTE: PLAN CHECK FEES DUE AT TIME OF SUB M` ITTAL ,F
Building Grading f—Drainage 'J/Elec >f�_ Mech
>?—"21um Cu Yd Cut[_ Cu Yd Fill
Project Address (Not mailing address) f- Flood
r Fire f- Liq jW Landslide I —N/A Floor Suite No
Description of Work
"•
Use � 2 ConstTyp e
# StoriesT # Units (if Res)[
017
Valuation $
Material/Labor �e7l*v
New/Add SF 1 �C/< �— Remodel SF Garage/New/Add I y—
OWNER'S NAME Last l/`�/�r Y/'t
First
Owner's Address
Owner's E-mail Address
City 1 (YM44 State Fi
Zip �j3 Telephone�W Y` / - l G U ` (5d
APPLICANT'S NAME Last WA
First f1
Applicant's Address
Applicant's E-mail Address
-
City y1:1�� z /VjGiq State l fAy Zip Telephonevw��T- �l
ARCHITECT/DESIGNER'S NAME Last �/(�`� First Lic. N
�1 o.
Architect/Designer's Address
�Ycq
Architect/Designer's E-mail Address
r/`��
-rr/P)
City l Telephone?/�¢2
ENGINEER'S NAME Last 41w,�p
First 1hVIA17— Lic. No
Engineer's Address
Engineer's E-mail Address
City State Zip
Telephone l.f 3-101, (T�
'-ONTRACTOR'S NAME/COMPANY Ul✓ 0 �.� � Lic. No. / Z01 ey Class
it rn5't�UC� 'U-P)
)ntractor's Address
y YU Vp
Contractor's E-mail Address
,71 ��Y���� b1Vj �'
-0 ( ��
{ g S � C--,ar7_C
ty ! o o-+ h l �1 State Tl Zip
: GQ Telephone * 9 - '7 6 2 - 3 3 S 3
-BACKS REAR SETBACKS FRONT
PERMIT NO.
'3ACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
ZONE DEVELOPMENT NO
PLAN CHECK FEES $