HomeMy WebLinkAboutX2021-3364 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division X
Comm'I Residential l NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Fx—Building r Grading x inage jX Elec CX Mech
� Plum CuvdCut F CuvdFill
Project Address (N mailing address) FX_ Flood
FX_ Fire r Liq FX_ Landslide IXN/A Floor Suite No
Description of Work
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Use fi Const Type "`
It Stories # Units (if Res)r—
S
Valuation a -7 C
Material/Labor ` J
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New/Add SF � Remodel SF rL o6 L/ Garag e/New/AddF_
OWNER'SNAME Last �il��,4c,,✓I
First
Owner's Address
Owner's E-mail Address
)I3 0 ro r /"-v c
City C ✓�1�t ire j W1 at Y State Cr>
Zip R7� 5 Telephone 7l5 ` car} ' C`7 js }
APPLICANT'S NAME Last rnyz;-yGY1f
First Vj-
Applicant's Address
Applicant's Er -mail Address
r
�7W �`1/ 10 � � W
} N 7JCbQ f&Y- C C;L z
City I CO . '�i vvyqcc State -
Zip ��, !� Telephone Cj'I-�e(- i0� �- 3 jl-t p
ARCHITECT/DESIGNER'S NAME Last 5\��� 4v\Ux'e_ First CL_ Lic. No. �—
Architect/Designer's Address
Architect/Designer's E-mail Address
_
City 0.� State � T
T�
i 1
Zip Telephone �r I `1
t V `l
ENGINEER'S NAME Last
First Lic. No.FUJZ`j
Engineer's Address
Engineer's E-mail Address
City State �
Zip F_ Telephoned
CONTRACTOR'S NAME/COMPANY iUh 5U)* (jP�
G� ° � �J il Lic. No. qoi �& ClassIL)
Cai,i �fiG
Contractor's Address
Contractor's E-mail Address
;I:r w 1¢/i 5 /
City COZA w'✓ 5 et State 7,,;-
Zip 5 Telephone C
SETBACKS REAR SETBACKS FRONT
PERMIT NO. VZk/ � 7�
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $