HomeMy WebLinkAboutX2021-1284 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application (10r Comm'I jG"\Residential City of Newport Beach - Building Division)(
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
[-Building Grading [-Drainage j_ Elec [- Mech
[- Plum Cu Yd Cut 1� Cu Yd Fill I ,S�
Project Address (Not mailing address) [- Flood
[- Fire r` Liq [- Landslide F_N/A Floor Suite No
Description of Work
Use F_ Const Type
Y3
# Stories # Units (if Res)
Valuation $ A j"I
Material/Labor
New/ Re d ISFF Garage/New/Add
OWNE ' NAME st C,� air c:%-
First e
Owner's Address
Owner's E-mail Address
C� V.,
City �ir .�-. State F�:]
Zip CL-y -L? Telephone Iq
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
2-4 -oS W � L)D 4-,�S �ityit 'fjO�L
City r o ( �� State TA
,r
Zip g 6 6 3 Telephone _Cl l' b
r
ARCHITECT/DESIGNER'S NAME Last F First � - Lic.No. c- t3`(,
Architect/Designer's Address
Architect/Designer's E-mail Address
51on - 1« v -
't
ki,`jr6k _GrC�- Vouch-c � 1- 6-0'w
City State I '� "
�' ��. r✓`'u'
Zip � Telephone Fq Lf-�kf
v First--- Lic.No.F—
ENGINEER'S NAME Last
Engineers Address
Engineer's E-mail Address
City F State �—
Zip �-- Telephone[ --
Lic. No. (° 5_�" Class
CONTRACTOR'S NAME/COMPANY ✓S L
1 _
p� g S i l✓h
Contractor's Address
p
Contractor's E-mail Address 1�
City (��c State FEZ
Zip -L(,(Telephone
SETBACKS REAR SETBACKS FRONT
PERMIT NO. • ��"�
RFTRACKS I. FFT SETBACKS RIGHT
PLAN CHECK NO. ,
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $1.E •y�