HomeMy WebLinkAboutX2021-0999 - Permit Application (3)Print For,,, Worksheet for Combo Building & Solar Permit Application o1—I
(— Comm'I JXResidential City of Newpo t Beach -Building Division X 2�r i �U o
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL `'<„o=+”
F' Building r Grading F -Drainage F_Elec F_Mech r Plum Cu Yd Cut r Cu Yd Fill
Project Address (Not mailing address) Flood f- Fire F- Liq r Landslide F_N/A Floor Suite No
Description of Work
Use F`ConstType F
# StoriesF—# Units (if Res)
s
ct O v c l d Ci 0 sv�
Valuation a O0/•"1.
Material/Labor � � IIJJ
New/Add SFF-� Remodel SF�— Garage/New/Add—
OWNER'S NAME Last PAOC ft- First 1
Owner's Address ' Owner's E-mail Address
jyr.7 C1 �. L,% iG<0"R'�^•YC ?� `.. _7 d
Gi /v-.,v� £�L'_ Ce...
_ .
City fv 3 (?C..r.`� '�.CL State C Zip Z/d Telephonef`
APPLICANT'S NAME Lastile- _ First
Applicant's Address Applicant's E-mail Address
City State F_- Zip r- Telephone-_.
ARCHITECT/DESIGNER'S NAME Last First F Lic. No. F_
Architect/Designer's Address Architect/Designer's E-mail Address
City State Zip F--_ Telephone---
ENGINEER'S NAME Last l [ First ; Lic. No.F --
Engineer's Address - Engineer's E-mail Address
City State C Zip. x'27 .I Telephone 'iib 43.1.:-TJ'Z 7
CONTRACTOR'S NAME/COMPANY 4 p Lic. No. �} Class FC, -I Y si Yd9�kji �d���P�
Contractor's Address // ontractor's-mail Address
`2 No�EEC9_ (cijCSFX'G L�S�v'JIk3Ccv-J )LYca .CGu�
City �.k aa"C /t State k- Zip Ci L1t�� Telephone r "iW �� t
SETBACKS REAR SETBACKS FRONT PERMIT NO. )Cf -O Ci( --(D ql q
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $