HomeMy WebLinkAboutx2021-3215 - Permit ApplicationX7,p21- 3216
Print Form Worksheet for Combo Building & Solar Permit Application
QCoresimm I dential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OPSURMrrTnl
FWilding r Grading (Drainage r Elec F_ Mech r Plum cuvdcutr— CuvdFill F_
Project Address (Not mailing address) r Flood r Fire r Liq r Landslide rN/A Floor Suite No
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#Stories #Units (if Res)l/&
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Valuations 4
Material/Labor
New/Add SF R e SF 20 Garage/New/Add----
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OWNER'S NAME Last r� �L(4f First
Owners Address Owner's E-mail Address.
—.._,...—_ TelephoneF_ -_ -....
City -. State ZIP
APPLICANT'S NAME Last 7_,/4 C First
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Applicant's Address Applicant's E-mail Address
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City 701,11,,156A /�ur-/..b State F—= Zip 2_ Telephone C'/�jy /— �14j'jrS -a�`j
ARCHITECT/DESIGNER'S NAME Last j /4�j' F`� First / h.iV1JLJ Lic: N
Architect Designer's AddressArchitect/Designer's E-mail Address f
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City "'�-�—Mate•" -.. _. _. ZiP Telephoner
ENGINEER'S NAME Last First L---- Lic. No.F-- --
Engineer's Address Engineer's E-mail Address -
City _. _ State F ZIP I---- TelephoneF--- - - -
CONTRACTOR'S NAME/COMPANY ,r� Lic. No. iClassr'�_
Contractor's Address tractor's E-mail Address
City State r-- Zip— — Telephone[
SETBACKSREAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $