HomeMy WebLinkAboutX2021-0570 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application ow
F-Comm'I F_ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
[-Building r Grading rDrainage r Elec r Mech r Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing
address) Flood f- Fire Liq F_ Landslide rN/A Floor Suite No
Descri ' of Work
Use F—Const Type F—
# Stories #Units (if Res)
Valuation I �� N-Q
Material/Labor
New/Add SF —i Remodel SF Garage/New/Add
OWNER'S NAME Last
Pr �(?� ECG. i First i
Owner's Address
Owner's E-mail Address
City �/�lo»� �(Jd
State r Zip �— Telephone��
APPLICANT'S NAME Last I KIIAl1 et"I y V7 First
Applicant's Address
/ Applicant's E-mail Address
ZCj°7d3i Ca-56C-
tyro 50j<,1`1A--t �%e6ao0 c0:1-,
City ��, SSrO 6� V �� .v
State C/"� Zip qL t'i l [.- Telephone a c..f if _ 3I U --j Z Z,f
ARCHITECT/DESIGNER'S NAME
Last First F_ Lic. No. F_
Architect/Designees Address
Architect/Designees E-mail Address
City I
State F_ Zip [ � Telephone[
ENGINEER'S NAME Last Firstf .---- Lic. No.F_
Engineer's Address
Engineer's E-mail Address
City--- - _ _
State- Zip Telephone
CONTRACTOR'S NAME/COMPANY _(A z (��r? lG[' i'o ,�Ct'r;rer• ✓1�_ Lic No. giho jr(7 ClassFA -)j�
rector's Address
Contractor's E-mail Address
z3 i z l a i1 a
i'70 5-0 Kka: , Olvp ,00 Cc3r1_1
City I L610e,
State Get Zip RZC,Cj Telephone qtf.3/0-732-4
SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $