HomeMy WebLinkAboutX2021-0785 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit
Con -m1 j Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBIVi
Building nGrading Drainage K-Elec Prklech Plum CuYdCut E
Address (Not mailing address) ❑ Flood n Fire rj Liq E Landslide
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Cu Yd Fill F7
F N/A Floor �Suite No
Description of Work
Use ert_v.'�onst Type
r ° # Storiess # Units (if Res)���)
— — — -------
Valuation $ 2 �j
New/Add SF �j Remodel SF Garage/New/Add �� Material/Labor 4i 1 1�
OWNER'S NAME Last ,44First _- —_
Owner's Address Owner's E-mail Address
City State (,/, Zip I "/ S Telephone
APPLICANT'S NAME Last
Applicant's Address
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city
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City ---O, Mc/,(7 State F( -A1
First
Applicant's E-mail Address
MI -1 kti1 j
Zip Telephone Z _ .Yi7j �ip
ARCHITECT/DESIGNER'S NAME
Last (�)v "p�,)> I Firstr—, 41
Architect/Designer's Address
City State L " r
Lic. No.G 11
Architect/Designer's E-mail Address I
Zip (j 660 Telephone qj I
ENGINEER'S NAME Last First F Lic. No.
Engineer's Address
I
City ---- --- ---- .I State
Engineer's E-mail Address
Zip �� Tel7l onll .
CONTRACTOR'S NAME/COMPANY0 I� h�iZ/"II �� Lic No. Cla
Contractor's Address
�cntractor's
E mail Address
CIt Ge-b±'v-��� State �C/� Zip _-q.5&q- Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO. �(-W ✓� 0'l y
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. 01? -5. 2.07,1
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $ 2 ♦ 152 .,+7