HomeMy WebLinkAboutX2021-0937 - Permit ApplicationI
Pri-t Form j Worksheet for Combo Building & Solar Permit Application
Comm'I j- Residential City of Newport Beach - Buildin Division �/ (1-D�
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL xfdo;
F_ Building F_Grading rDrainage rElec rMech F- Plum CuvdCut F CuYdFill F
ect Address)
j` Flood F- Fire F- Liq r Landslide
22/ C�) 17
Description of Work ,''— i ", / f l c c 3
c._/ !�_ Cc l� c= ✓L ���7-cti .'{zxJ'g./�� n -7 Q vr=
New/Add SFF— Remodel SF F--- Garage/New/Add
OWNER'S NAME Last I 1? L n I� H „�L ` J First
Owner's Address Owner's E-mail Address
F_N/A Floor
_ I
Suite No
Use ConstType F_
# Stories[— # Units (if Res)[ —
Valuation $ -
Material/Labor
City
State
F_
Zip F—
Telephoner
APPLICANT'S NAME Last I S <
First) /�sZ//)
Applicant's Address Applicant's E-mail Address
9 Z 4 ? f c�Tr��C E� C ��/7�� ✓�. ac y
City State C� Zip �— Telephone
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State F— Zip I Telephone F_
ENGINEER'S NAME Last I 1j-O-
Engineer's Address
City State F_
First ,.-— LicNo.F--;:--
Engineer's E-mail Address 1�
Zip F_ Telephoned
CONTRACTOR'S NAME/COMPANY li� �, HUrk`,, LicNo. r — Class
Contractor's Address Contractor's E-mail Address
City tiC-- �:,>— State I � Zip F Telephone
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
PERMIT NO. X 7 U I V H 7
PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $