HomeMy WebLinkAboutX2021-1892 - Permit Application2LYA Sqb§5
P�intForm' Worksheet for Combo Building & Solar Permit Application
Comm'I [-Residential City of Newport Beach -Building Division NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
[—Building [-Grading [-Drainage [-Elec [-Mech [-Plum Cu Yd Cuts Cu Yd Filll
Project Address (Not mailing address) I` Flood C Fire [- Liq [ Landslide [-N/A Floor Suite No
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Description of Work
Use F Const Type s
# Stories # Units (if Res)[_
Valuation $
New/Add SF Remodel SF F Garage/New/Add r_—
Material/Labor
First S i'
OWNER'S NAME Last Cl
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Owner's Address Owner's E-mail Address
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City - CD D'. a e�Q I/i/ -V_ State - c� Zip q z.(Q.2 ,J. Telephone 2(. I. q'(. s G _I 6 3 (.O
APPLICANT'S NAME Last First k�j,-,
Applicant's Address Applicant's E-mail Address
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City I�v.r'tdG'�.J r?jc,..t5 State Grk- Zip 5 - Telephone Q/`Fg.�do (,!L
ARCHITECT/DESIGNER'S NAME Last First F_Lic. No. F—
ArchitectIDesigner's Address Architect/Designer's E-mail Address
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City State f . Zip F---. Telephone
ENGINEER'S NAME Last First F— Lic. No.r—
Engineer's Address _ Engineer's E-mail Address
City State F------. Zip F_ Telephoned—
CONTRACTOR'S NAME/COMPANY t �: Lic No. ! y _0_3 S Class
Contractor's Address Contractor's E-mail Address
City L� r'cNc/a�/�. State (Zk Zip -s----- TelephoneFa—_
SETBACKS REAR SETBACKS FRONT PERMIT N0. —�zcrz
SETBACKS LEFT _ SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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