HomeMy WebLinkAboutX2021-2950 - Permit ApplicationPrint Farm j Worksheet for Combo Building & Solar Permit Application o" '°"'m
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r Residential City of Newport Beach - Building Division a
I L% NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTA,
YJBuilding F7Grading F-Drainage I-Elec F_Mech
((Project
hPlum CuYdCut CuvdFill
Address (Not mailing address) r Flood
j- Fire F- Liq F- Landslide FN/A Floor Suite No
I F_
Description of Work
Use F—ConstType
#Stories # Units (if Res)[_
New/Add SF� Remodel SF Garage/New/Add �—
Valuation $ 9.
Material/Labor
OWNER'S NAME Last /� �� L Qy
First
Owner's Address
Owner's E-mail Address
c� 7 3 e,Jv. c e
—�M vJ awn cc)
City N PnW&1 State f c\
Zip F TelephoneRy�Z
APPLICANT'S NAME Last Y (�
First ( . Q,a
Applicant's Address
Applicant's E-mail Address
\
1A co<r(I-V -.I �o'M
City State
Zip _ �? Z(�5; Telephone C 4'6' 1)j I
ARCHITECT/DESIGNER'S NAME Last
Lic. Na.
First F_
Architect/Designer's Address
Architect/Designer's E-mail Address
City State F_
Zip F— Telephone�—
ENGINEER'S NAME Last First Lic. No.F—
Engineer's Address
Engineer's E-mail Address
City State I
Zip F Telephoned
CONTRACTOR'S NAME/COMPANYUL -,i�L,- , Lic. No. Class t
i�t, 1_ '(,�lU'nl �'OS $�Z
Contractor's Address
Contractor's E-mail Address
nn nn
City U rP- E State F_C11F_
Zip c(Z&4 Telephone 6ut)s) -11,/L
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $