HomeMy WebLinkAboutX2021-0493 - Permit Application,t corm Worksheet for Combo Building & Solar Permit Application
C; Comm'I Residential City of Newport Beach - Building Division Jam/ Gr?J
NOTE: PLAN CHE,PK FEES DU�,AT TIME OF SUBMITTAL v I I
Muilding CGrading [,Drainage�Elec `jEMech Plum cuvdCut- cuvdFill17
Project Address (Not mailing a/dddress) SSE, Flood [ Fire E- Liq [ Landslide ❑N/A Floor Suite No
New/Add SF�-- Remodel SF rl 3-c5b Garage/New/Add
OWNER'S NAME Last
Owner's Address
city I Nfy
APPLICANT'S NAME Last
First I .
ConstType
# Stori®# Units (if Res)C
Valuation $
Material/Labor
Owner's E-mail Address
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State I_ Gj,4S- Zip
Applicant's Address
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City LAGL k WU*s State ,
First
Applicant's E-mail Address
OILL Q W IL.LJAM 44,q 5 wi , ,?,crt,rrc =r . WM
Zip g2k3 Telephone C%/ y27.dr-&8
ARCHITECT/DESIGNER'S NAME
Last �M�Sc� First (JL(k Lic. No. Z3 S
Architect/Designer's Address
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City L�6Cfw� V i State �,
Architect/Designer's E-mail Address
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Zip qZ ;,7 ,Telephone C% )422 6ase,
ENGINEER'S NAME Last First s Lic. No. 5
Engineer's Address
(?291 irw)Nf_:- t3�vt7 !S"2
City '( ()s-L? State Cfi}
Engineer's E-mail Address �.
Zip 9278xZ) _ Telephone C�/4%4-2537
CONTRACTOR'S NAME/COMPANY Lic. No. I — Class F_
Contractor's Address
City State
Contractor's E-mail Address
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Zip �— Telephone
SETBACKS FRONT
SETBACKS RIGHT
DEVELOPMENT NO
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEES $
Print Form Worksheet for Combo Building & Solar Permit Application
F- Comm'I j- Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building FGrading [-Drainage F_Elec (-Mech Plum Cu vd Cut Cu vd Fill
Project Address (Not mailing address) F_ Flood F_ Fire F_ Liq j- Landslide F_N/A Floor Suite No
Description of Work
Use F—Const Type
# StoriesF_ # Units (if Res)F_
Valuation
New/Add SFF— Remodel SFF—Garage/New/Add F
$
Material/Labor
OWNER'S NAME Last
First
Owner's Address
Owner's E-mail Address
City
State Zip F Telephoned
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City
r State I Zip F_ Telephoned
ARCHITECT/DESIGNER'S NAME
Last First Lic. No.
Architect/Designees Address
Architect/Designer's E-mail Address
City
State Zip Telephone[
ENGINEER'S NAME Last
First F Lic. No.f
Engineer's Address
Engineer's E-mail Address
City
State F_ Zip r Telephonef
CONTRACTOR'S NAME/COMPANY
p� / G �g Lic. No. _�i_1 Class
in T Ors S �YC �C di
Contractors Address
Contractor's E-mail Address
6Arc"
City
�� S CC J }Yc�L iGot
StateFT /T Zip � 0 Telephone
r� �� ���
1
SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $