HomeMy WebLinkAboutX2021-2013 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
r Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
7�Building Grading y4Drainage j/Elec Nech ,Plum CuvdCut l CuYdFill I Q
Project Address (Not mailing address) r- Flood (= Firer Liq j Landslide F)(N/A Floor Suite No
Description of Work
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Use Const Type V (�
# Stories[ # Units (if Res)FT
Valuation $
Material/Labor 501 0.�•
New/Add SF� Remodel SC3 2; 5, j5 Garage/New/Add F
OWNER'S NAME Last jc iZ First
Owner's Address Owner's E-mail Address
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city State �— Zip q2 Telephone ry ,7 -162.y
APPLICANT'S NAME Last �t� 5.i't First
Applicant's Address Applicant's E-mail Address
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City F�f;laState CA� Zip � 'j Z-j Telephone 7f, 6t2_r� �v
ARCHITECT/ €SIGNER'NAME Last A„g_D,j First VU�W Lic.No. F_
Architect/Designer's Address Architee�ctlDesignter'ssEE-`mail Address
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City . ��'t - State �- Zip y!Z, -' 7 Telephone
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ENGINEER'S NAME Last First �11-l� Lic. No.Co-7
Engineer's Address Engineer's E-mail Address
city �� PA_ State I Ck Zip y Z1o1 Telephone `tl Yb`fQ
CONTRACTOR'S NAME/COMPANY �'L� (,G �Y �Z o� Lic No. FS130 3 Class
Contractor's Address Contractor's E-mail Address
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City I U10o`St- State [Lf Zip � Telephone Z � � 2 '7
SETBACKS REAR SETBACKS FRONT PERMIT NO. AV ZI � Z4I3
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO :"�`N12 PLAN CHECK FEES $