HomeMy WebLinkAboutX2021-1052 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application)
Comm'I residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
fga4ding F_ Grading r`Drainage F_ Elec F- Mech F_ Plum CuYdCut CuvdFill J
Project Address (Not mailing address) F_ Flood F_ Fire F_ Liq r- Landslide F_N/A Floor Suite No
Description of Work
New/Add SF
OWNER'S NAME
Owner's Address
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city I `�
Remodel SF F?_If§�
Last A4__�
Garage/New/Add
First ) -��
Owner's E-mail Address
Use I)t L Const Type
# Stories[ # Units (if Res)FF
Valuation $
Material/Labor '(7eo
State F_� Zip r� 'LfC Telephone % (4a)-�� 9 170
APPLICANT'S NAME Last I C�,\.7 L_ lFirst I�w
Applicant's Address Applicant's E-mail Address
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City NU i�� State �� Zip 3 Telephone[ig
ARCHITECT/DESIGNER'S NAME Last I (,ArJ l._ (,
Architect/Designer's Address
City r�j State
ENGINEER'S NAME Last r -
First #49::) Lic.No.
Architect/Designer's E-mail Address
Q I I e,SIh•
Zip ✓f91� TelephoneFg- T,
First Lic.No. '�23�5
Engineer's Address Engineer's E-mail Address
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City OState Zip Telephone Sro2 2 5-5!
CONTRACTOR'S NAME/COMPANY C Lic. No. F IDS 5-(0 Class
Contractor's Address Contractor's E-mail Address
30
city fosf/�CSo� State Zip q Z 426 Telephone Fqq /( 3-/� (Z�
SETBACKS REAR
SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECJ([(;��
USE ZONE DEVELOPMENT NO PLAN CHE KVEIT