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HomeMy WebLinkAboutS2021-0035 - Permit ApplicationHrint Form II Worksheet for Combo Building & Solar Permit Application Comm'I .Residential �ZUZ V —0035- City of Newport Beach - Building Division I o y 6 k_eKj_ L vt NOTE: PLAN CHECK FEES DUE AT TIME OF, UBMITTAL ('Building r Grading rDrainage r Elec j` Mech r Plum Cu Yd cut Cu Yd Fill Project Address (Not mailing address) I— Flood r Fire r Liq r Landslide rN/A Floor Suite No Description of Work Use ConstType �—#Storiesr—#Units(ifRes)r INC, r� cf °v� e�'J�i�9 V66 1c.1�/ New/Add SFF— Remodel SF 5-'/y Valuation $ Garage/New/Add �— Material/Labor 2Z /060 OWNER'S NAME Last,^ /' First Owner's Address Owner's E-mail Address City /i/ewl,711- State G� Zip g'266'0 Telephonegyy 3yy__qv APPLICANT'S NAME Last josplc./ First Applicant's Address Applicant's E-mail Address Coo (4/ r4 444 city 6i�j� State /�— Zip lZ p�5 Telephone ga?zec3y� ARCHITECT/DESIGNER'S NAME Last ( , l 0 N� First Lic. No. F— Architect/Designer's Address ArchitecUDesigner's E-mail Address City J State F— Zip F— Telephone[— ENGINEER'S NAME Last I �/j First !/ /r Lic. No. Engineer's Address Engineer's E-mail Address City r— State r— Zip F — Telephone[— CONTRACTOR'S NAME/COMPANY �n/ UN���/ Lic. No. Class wr� � �o�/ c-sj Contractor's Address City I 0�°1 Z I SETBACKS REAR I SETBACKS LEFT State I `4— SETBACKS FRONT SETBACKS RIGHT USE ZONE DEVELOPMENT NO Contractor's E-mail Address 1 N//4 Zip 1 42 ft5 Telephone Vji9) ?,7.��Oo PERMIT NO. 5 C) Z PLAN CHECK NO. uz 7,©Z( PLAN CHECK FEES $