HomeMy WebLinkAboutX2021-2035 - Permit Applicationx 2021.20W
Print Form Worksheet for Combo Building & Solar Permit Application an-,
Comm'I City of Newport Beach Building Division
F- r Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
[-Building [-Grading
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Project Address (Not mailing address) F- Flood f- Fire F Liq ❑ Landslide rN/A Floor Suite No
Description of Work
Use F Const Type F—
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# Stories # Units (if Res)[—
New/Add SF
Remodel SFrT-Jwiiiw Garage/New/Add F
Valuation$ �g-9dj
Material/Labor ff N
OWNER'S NAME
Last G0_rv5 First
Owner's Address
Owner's E-mail Address
City
State r— Zip I _ Telephone—
APPLICANT'S NAME
Last //7, First e
Applicant's Address
Applicant's E-mail Address
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State_f-'c4 Zip °!2870 _ .Telephone 7'45'_,-Z13
ARCHITECT/DESIGNER'S NAME
Last First --- Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City _
_ State r_-_— Zip.--- Telephone----.—
ENGINEER'S NAME
Last First F. -.-- Lic. No.1
Engineer's Address
Engineer's E-mail Address
City
State F- Zip I Telephonef _- ------
CONTRACTOR'S NAME/COMPANY Lic.No. `�CSSiv Classy'
J r'1LL orf f G r S C
Contractor's Address
- Contractor's E-mail Address
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.City t�- _i n'ce.L,
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State C Zip---- Telephoner
SETBACKS REAR
SETBACKS FRONTr'
PERMIT N0. x2,Q2' ° I b�Y✓' �L
SETBACKS LEFT
tG?�'7-I•b�¢S'�
SETBACKS RIGHT PLAN CHECK NO. I1re8.2U�(.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $