HomeMy WebLinkAboutX2021-1383 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
F_ Comm'I F_ Residential City of Newport Beach - Building Division p
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building F_ Grading [—Drainage XElec rMech
XPlum cuYdCut CuYdFill
Project Address (Not mailing address) F_ Flood F_ Fire f` Liq f - Landslide FN/A Floor Suite No
Description of Work
V
Use Const Type V �
►1TC{.%
# Stories[ # Units (if Res)[
U V "J U i2cZ:;,t1 G �alw �ri t stela/
Valuation
New/Add SF ----- Remodel SF Garage/New/Add
I I
Material/Labor
OWNER'S NAME Last I -'ry '�
First c-z�
Owner's Address
Owner's E-mail Address
1.m c-om
City Q(2r VTR- State t=A6
Zip I'1 2- ""D Telephone 7w'
APPLICANT'S NAME Last
First F
Applicant's Address
Applicant's E-mail Address
Ila2. t-�N �•
J�c'c'�f �dt�ahl�.ver-��n.n�-f'
City yl7j�y,,�-j� 'R� t State I
Zip Ot2r�4g Telephone 7jq'3�_ �
ARCHITECT/DESIGNER'S NAME Last. First Lic. No.i�810
Architect/Designer's Address
Architect/Designees E-mail Address
Ild2 1ni �-.
�{edahl�v�rtzr�vl.n
City tg- State �_
Zip Telephone SIBS- G,-G[,D
ENGINEER'S NAME Last�,/\�(/ i_ p
First I rr, u � Lic. No.C_-ec s2o
Engineer's Address
Engineer's E-mail Address
l�S^to 1 �4,+>�-�,c_vo. s.22o �reG-� be'for�d�l-�t�rir�inc.c�rrt
City �jWw VA,4_1p� State lye
Zip JOZ.&U Telephone C3i0,793—c`34-bo
CONTRACTOR'S NAME/COMPANY
Lic. No. ��� 1�Class�
�a.1�'R • J
U
Contractor's Address
Contractor's E-mail Address
City State r
Zip Telephoned
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. I ZZ fUSE
ZONE DEVELOPMENT NO
PLAN CHECK FEES $