HomeMy WebLinkAboutX2021-2417 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application Qswm4
City of Newport Beach - Building DivisionComm I esidentialNOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F_ Building F_ Grading Drainage rElec F—Mech F_ Plum CuvdCut F cuYdFill
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Project Address (Not mailing address) F Flood j— Fire F_ Liq r Landslide F_N/A Floor Suite No
Description of Work
Use F—Const Type F
# Staries7 #Units (if Res)
-}� P4 Q!c +raNnscr Jac . _E
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Valuation $ y—
Material/Labor �v
New/Add SF�� Remodel SF� Garage/New/Add F—
OWNER'S NAME Last Yap First I C
Owner's Address Owner's E-mail Address
City State �— Zip F Telephoned --
APPLICANT'S NAME Last. �( jl First J(¢�
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Applicant's Address Applicant's E-mail Address
314 /,✓c--- LV K,y
State Zip C
City St Cn P �7EZjTelephone[1 �}ZL �LL7
ARCHITECT/DESIGNER'S NAME Last AY 11_ First Www Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State F— Zip r— Telephoned
ENGINEER'S NAME Last First Lic. No.F_
Engineer's Address Engineer's E-mail Address
City State Zip �— Telephoned
CONTRACTOR'S NAME/COMPANY Lic. No. 6ia%Z- Class
Contractor's Address Contractors E-mail Address
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City KL, � b, !i R't-- yr / y L. State Zip t �C, Z S TelephoneF) q Z a `C
NO. 1 _ "
SETBACKS REAR SETBACKS FRONT PERMIT n VA
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. l
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USE ZONE DEVELOPMENT NO VU "l t PLAN CHECK FEES $