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HomeMy WebLinkAboutPV2021-092 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application ofEWIRre F-- Comm'I F,{ Residential City of Newport Beach - Building Division 1= NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL I d i n g F- Grading [-Drainage F Elec F_ Mech F Plum CuYdCut � CuYdFill Project Address (Not mailing address) F_ Flood F- Fire F- Liq r Landslide FN/A Floor Suite No 9SO(e �k 12 e�4 A), e3, cps 926P6 3 — F ( Description of Work Use Const Type #Stories # Units (if Res)F �2Kw 13,o s ©ru 1,wtr�, Z?!®,7Ts,c �� $ F13 Material/Labor< 0 o a 7Valuation New/Add SF Remodel SF — Garage/New/Add �� OWNER'S NAME Last 17QiJ a First F4;" /� V Owner's Address Owner's E-mail Address Zgb G, La -a �./r� City / V �� � State F `i Zip Telephone [4 1(� - 4? 7 APPLICANT'S NAME Last First ' ' Applicant's Address Applicant's E-mail Address 1,51 ,A.t /(9t S 6 rr �1 tIGQC Sal , c _ City ,rt� , . State �C�- Zip Ct 2 & 2_7 Telepho✓ne u 24 ! 3 C&y G ARCHITECT/DESIGNER'S NAME Last First Lic. No. F Architect/Designer's Address Architect/Designer's E-mail Address City �— State �� Zip F— Telephone ENGINEER'S NAME Last ��e" ,,, _ �� First Lic No.� `� Engineer's Address Engineer's E-mail Address City /H, 8 State �� Zip -/ c// _ Telephone) CONTRACTOR'S NAME/COMPANY Lic No. /?lass�(Q* Contractor's Address Contractor's E-mail Address ti 3 3 N'.k.11 Si— 7 — City 0b.'sit,- State I C�It Zip �t�ZT Telephone c/ r SETBACKS REAR SETBACKS FRONT PERMIT NO. T SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. USE ZONE DEVELOPMENT NO PLAN CHECK FEES $