HomeMy WebLinkAboutX2021-2086 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application
Tx Comm'I rX Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL X dv
Building r Grading FX`Drainage [X_ Elec (X Mech
Fx- Plum CuYdCut F CuYdFill F
Project Address (Not mailin address) Fx Flood
(x Fire jx Liq rx Landslide �N/A Floor Suite No
'•� �� / R'T G v rtn �i
Description QfWork
Use F ConstTypeF
Z' TALC X&—TAIAI)AlCr w/i L (i0 G 141e,14- FEE-T
# Stories # Units (if Res)7
Valuation $
New/AddSFF— RemodeSFr Garage/New/AddF_
Material/Labor JD
OWNER'S NAME Last CTR
First h '
Owner's Address
Owner's E-mail Address
J' Pa//vT GOYVY7-
City Cz7 !""V 1 State C A
Zip w TelephoneF_
APPLICANT'S NAME Last First i;e_ --
Applicant's Address
Applicant's E-mail Address
277,Y pAST HV1y
G^1c CJ Sri c' clJen,f{ j/0M. cci�
City �C/�7vl State rA
Zip C1 2 F 2�j TelephoneF
ARCHITECT/DESIGNER'S NAME Last S A /vl C
First F Lic. No. -
Architect/Designer's Address
Architect/Designer's E-mail Address
City F _ State F_
Zip !�— TelephoneF_
ENGINEER'S NAME Last Gp����
First 4 A La- Lic No. e 3 Eg p
Engineer's Address
Engineer's E-mail Address
LlNf3
c�eqz(� i�C Me. �o
City J A", I A pl�jn State
Zip -1 17,1 � Telephone %V t
CONTRACTOR'S NAME/COMPANY
Lic. No.% ClassF
Contractor's Address
Contractor's E-mail Address
City [— State �
Zip I __ Telephoned
SETBACKS REAR j'l , (� a t SETBACKS FRONT
Cam' PERMIT NO. / 1�aZ I •%OPAL
SETBACKS LEFT Jj i SETBACKS RIGHT
�✓ PLAN CHECK NO. b(00(7✓�
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $�