HomeMy WebLinkAboutX2021-1994 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
F_ Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
J;�,Building F_Grading
[—Drainage F_Elec r"Mech rPlum CuvdCut Cu Yd Fill
Project Address (Not mailing address) F_ Flood F- Fire F- Liq F= Landslide FN/A Floor Suite No
I's S�ak
pr • � �&S� � F
Description of Work
Use F—Const Type F_
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�JLr-�f((14L n/t �Qt/y�O OIY.Y
# Stories # Units (if Res)F
Valuation $
Material/Labor
New/Add SFj�
I _.
Remodel SF o 1g _ Garage/New/Add a/New/Add r- ---
>/CJ 9
OWNER'S NAME
Last 5unaer,M6-A First F h oc
Owner's Address
Owner's E-mail Address
Is
City ._
-.... - State r Zip q 266, T - Telephone -_. _._.....
APPLICANT'S NAME
Lash First lS
Applicant's Address
Applicant's E-mail Address
City (. ivo- 6keslx
State CT Zip cijZv2,& Telephone i)q -732 —02156 -
ARCHITECT/DESIGNER'S NAME Last��
_�,U�,�-� First _ �v Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City �-'b�- e
_..... State I & Zip -2& Telephone 1II/t19,2'8'256
ENGINEER'S NAME
Last rYV,n,, First ���1"V�U� LIC. No. F�--
Engineer's Address
Engineer's E-mail Address 76 7�j6 ( 1
City59.✓QG1
State Zip G12,13'Zl Telephone QOQ, '56q -l`b(6C -
` • \\ eS S G'(,o Lic. No. f (�cJ � Classy
CONTRACTOR'S NAME/COMPANY OI
�]
Contractor's Address
Contractor's E-mail Address
City F_—
State �— Zip I—-. Telephoned ----
SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. t,'� q-7 _
USE ZONE
f
I
DEVELOPMENT NO PLAN CHECK FEES $