HomeMy WebLinkAboutX2021-3407 - Permit ApplicationPrint Form._.� Worksheet for Combo Building & Solar Permit Application o�EW�a>m
City of Newport Beach - Building Division a q
Comm'I 9' Residential NOTE: PLAN CHECK FEES DUE AT TIME 0f SUBMITTAL
[—Building F7 Grading j-Drainage r Elec r Mech F Plr°71e, dCut �cfCgYd Fill
Project Address (Not mailing address) r Flood ��irze$jq III j—N/A°Floor Suite No
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Description of Work
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UsA SType FM
# Storie5� # Units (if Res)F-
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New/Add SF F_Remodel SFF Garage/New/Add7—
Valuation $ 3 00
Material/Labor
OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
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City n ld Qr-t_C State �— Zip G� e,�®3 Telephone rj 6 .� Q,C�G - OB-.( --
APPLICANT'S NAME Last S qfr\- KC+StS��` First
Applicant's Address Applicant's E-mail Address
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City C � q ,,LjL State I "' Zip nt 3 021 Telephone g05- _. - ..
ARCHITECT/DESIGNER'S NAME Last Q Qgpt SS t First E t♦ R L) (J Lic. No. 7 SSFr.cf
Architect/Designer's Address Architect/Designer's E-mail Address
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City i�U State (�} Zip ] (i,� Telephone 7(It-'-715—iD� � 3
ENGINEER'S NAME Last First Lic. No.F_—
Engineers Address Engineer's E-mail Address
City F_ State Zip F Telephoned
CONTRACTOR'S NAME/COMPANY �7UD L Lic No.F Class
Contractor's Address Contractor's E-mail Address
City State F Zip Telephone
SE I BACKS REAR SETBACKS FRONT
V I PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK N0. 17
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $