HomeMy WebLinkAboutX2021-0246 - Permit ApplicationPrint Form 9 pp
_ orksheet for Combo Building Solar Permit Application o4�EWPogm -
r Comm'I F_ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL hoar'
Building r Grading rjrainage I—Elec j Mech
rPlum CuYdCut CuYdFill
Project Address (Not mailing address) F_ Flood r Fire r Liq r Landslide FN/A Floor Suite No
7-
Description of Work S /
Use F—ConstType F
# Stories # Units (if Res)[
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New/Add SF Z 0 Z- Remodel SF /I �, Z Garage/New/Add r
Valuation $
Material/Labor
OWNER'S NAME Last 1 /1;4 i ` i C i .S
First i L /
Owner's Address
H
Owner's E-mail Address W Cj � � i ''� 20
VC�S�I� L3C'' Vo�t�v.ro
City �✓i ✓Y� %: r �� L {/ State L i f
Zip 2(;%v3 Telephone[ 3l o - zi 5 �(
/ VY
APPLICANT'S NAME Last Sh 2 d.N N c. First
Applicant's Address
Applicant's E-mail Address
City F_ State ��
Zip �— Telephoned`
ARCHITECT/DESIGNER'S NAME Last (_. E" /5 }F i,a =I
First 7 11�?, L Lic. No.
Architect/Designees Address
Architect/Designees E-mail Address
f_/ciL
City C S' y?,v� L /CS State (_ 1
Zip 0 6 tf & Telephone 7/ y- S O/ 9 $ Zt
ENGINEER'S NAME Last [
First j -f aj n/(� Lic No. 5'y 7
Engineer's Address
Engineer's E-mail Address
_? CJ Z �l (�I S C,/L , i v it,
"/ II is "a j I t ,S G C- D
City I A< <? )- .q State � A
Zip c/ U (� Telephone ( Z- - '- rf (j 7- 3 � O D
CONTRACTOR'S NAME/COMPANY G /✓ Lic. No. F` Class F_
Contractor's Address
Contractor's E-mail Address
City � State F
Zip F_ Telephoned
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $