HomeMy WebLinkAboutX2021-3250 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application°YPm
F_ Comm'I F_ Residential City of Newport Beach - Building Division K7PZt
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F—Building (— Grading F—Drainage [_ Elec r Mech
F- Plum CuvdCut F CuvdFill F
Project Address (Not mailing address) F_ Flood r— Fire F— Liq f— Landslide I —N/A Floor Suite No
-70 2 ihr 1< t i.
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Description of Work
Use F Const Type r—
E!L?2 V (S%1 �[ Sr— R
tl (� nIG�—
# Stories # Units (if Res)[—
Valuation
Material/Laa bor
New/Add SF Remodel SF F— Garage/New/Add r—
OWNER'S NAME Last YJ t J J t �. /,
First S J � p+/J 1 r~_ e "
Owner's Address
Owner's E-mail Address
City ' CGJ U2-�� sr} State r l.. --
Zip 7ZvG / Telephone 6 26 Q6 Lf 3 7
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APPLICANT'S NAME Last��'1� �z�
First I
Applicant's Address
Applicant's E-mail Address
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h,tr 1-1/ems
City �U; S i b��e�7',t-- State (.�yd----
Zip �tJ'2 �% Telephone �J(FC( — 27cj —S � / C'
ARCHITECT/DESIGNER'S NAME Last
First —Lic. No.
Architect/Designer's Address
ArchitectlDesigner's E-mail Address
City State F—
Zip Telephoned
ENGINEER'S NAME Last
First F_ Lic. No.F
Engineer's Address
Engineer's E-mail Address
City F State F_
Zip F— TelephoneF_
CONTRACTOR'S NAME/COMPANY - z.c
80, ' ti, L,Lic. No. 6:37 Classn
Contractor's Address
Contractor's E-mail Address
Cityl�C�jj--- State �r---
Zip Z�Z7 Telephr�F&�f Z77
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. �JrO l s ZOZ'
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $