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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