HomeMy WebLinkAboutRev21-1483 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application PEW°�RT
F_ Comm'[ F- Residential City of Newport Beach - Building Division
NOTE. PLAN CHECK FEES DUF AT TIME OF RI IRnnITTnI � c.
rBuilding f—Grading \F'.
F Drainage [ElecrMech ;Plum Cu YdCutF Cu YdFillF
Project Address (Not mailing address) F Flood r" Fire [ Liq F_ Landslide F_N/A Floor Suite No
Description of Work Use F_ Const Type F
Apo � aim T=tt=i-t_D,� s It J 'W/Au<\,,/A-r,
#Stories #Units (if Res)
._._I4�
Valuation $ �
New/Add SF�— Remodel SF �— Garage/New/Add Material/Labor
OWNER'S NAME Last l Lr
( _ First. �1*�,•,it�"l
Owner's Address Owner's E-mail Address
City rJSTI State ICS ZIPF9 Telephoned
APPLICANT'S NAME Last ' / _ ® First L
Applicant's Address Applicant's E-mail Address
City 10_S T L State Zip 7 0� Telephone q ct, S_
ARCHITECT/DESIGNER'S NAME Last First —
Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State F_ Zip Telephone�—
ENGINEER'S NAME Last F First F Lic. No.�
Engineer's Address Engineer's E-mail Address
City State F Zip - Telephoner
CONTRACTOR'S NAME/COMPANY I 1 C tj Lic No. � l b 7 Class �—
Contractor's Address Contractor's E-mail Address
City I L V cvT G State I(Z,4-.,— Zip 9 2 7 0 Telephone -7L-1 e -2S 1- 7.2,72-
SETBACKS
.2,7 —
SETBACKS REAR SETBACKS FRONT PERMIT NO. y
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $ X