HomeMy WebLinkAboutX2021-1061 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application^ra
j` Comm'I F_ Residential City of Newport Beach - Building Division a'
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL �.oa,.'
F-Building F Grading (-Drainage F_ Elec j- Mech
r Plum Cu vd Cutl Cu Yd Fill F
Project Address (Not mailing address) F_
F Fire f"- Liq j_ Landslide FN/A Floor Suite No
4Z-2 Al �t
/irowp�c� ��4ch F
Description of Work
Use Const Type F
# StoriesT # Units (if Res)F—
Valuat on $
Material/Labor
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New/Add SFF— Remodel SF�— Garage/New/Add I 4
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OWNER'S NAME Last "'T-�G �i��w0 First _
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Owner's Address
Owner's E-mail Address
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City tv?,,v�,k �- -rW44 State CA
Zip `)2 Telephone
APPLICANT'S NAME Last M-?h f
r'} e First .`$ q v
Applicant's Address
Applicant's E-mail Address
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City L �} G• Uni A I LL S State �`
Zip .y z 6>=, ? Telephone
ARCHITECT/DESIGNER'S NAME Last /V Lic. �r First C No. F_
v 1 k F?
Architect/Designer's Address
Architect/Designer's E-mail Address
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'D k A /1' c 9 CC't>
City Z' `� c, \ V State ` 4
Zip 9 6 f Telephone k � 33 C
ENGINEER'S NAME Last
First F Lic. No.F—�
Engineer's Address
Engineer's E-mail Address
City State F_
Zip TelephoneF_
CONTRACTOR'S NAME/COMPANY AY11Q�S1LfiNo. 1E �,Class�
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Contractor's Address
Contractor's E-mail Address
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City so, /yc C State L
Zip `i� �- Q Telephone q 1,q -�� -Cj6�9
SETBACKS REAR SETBACKS FRONT
PERMIT NO. � � I -- I Q_(2
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. QCf �
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $
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