HomeMy WebLinkAboutX2021-0102 - Permit Application (3)Print Form Worksheet for Combo Building & Solar Permit Application ocEy:`°a>m
r Conrl FQ3esidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME nR si IRMITTAI —
j�Building F_ Grading F—Drainage WElec rMech ,Plum cuYdCut cuYdFill
Project Address (Not mailing address) I— 'Flood' r Fire r Liq r Landslide r_N/A Floor Suite No
Description of Work
Use Con stType F
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# Stories # nits (if Res)F—
Valuation $
SO 000
Mateiial/Labor !
New/Add SF /� Remodel SF — Gara ge/New/Add
9, r
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OWNER'S NAME / Last w�/�i`/.. First
Owner's Address Owner's E-mail Address
City nL /.. State Zip Tel hone
APPLICANT'S NAME Last Q� First
Applicant's Address
Applicant's E-mail Ad ass
/y�v 11-114�-1 z3_la�ti�mes
/ rpp ///zca . cam
City State IC/✓j Zip G6� ((� Telephon
ARCHITECT/DESIGNER'S NAME Last GO-LIJI First ,�
I 1 G,'jG� Lic No. F—
Arch itect/Designer's Address f Architect/ Designer's E-mail Address
City State F— Zip �— Telephones
ENGINEER'S NAME Last F-- First F Lic. No.r
Engineer's Address � �" Engineer's E-mail Address
City State F— Zip F_ Telephoned
CONTRACTOR'S NAME/COMPANY LiNo. Class
i� 7 15
Contractor's Address Contractor's E-mail Address
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City �,yy � State — Zip ,0�6j1 Telephone m 6S3
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SETBACKS REAR SETBACKS FRONT PERMIT NO. x aOZ I —� OlL
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. r)
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $