HomeMy WebLinkAboutX2021-3240 - Permit Application� ;pnnt Form Worksheet for Combo Building & Solar Permit Application
F_ Comm'l F-, Residential City of Newport Beach - Building Division X 14Z1 - �7_q V
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
[—,Building F_ Grading F -Drainage F_ ElecFM,ech 11 - F Plum Cu yd CVtF Cu Yd Fill F
Project Address (Not mailing address) F Flood F_ Fire F,_ Liq- Landslide [N/A F Floor Suite No
Z31� 60,flwu pit.
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Description of Work
Use Const Type
# StorlesF # Units (if Res)F
Valuation $
New/Add SFI, Remodel SFF77777Garage/New/Add 177 Material/Labor F
OWNER'S NAME Last First AAA -9I
Owner's Address Owners E-mail Address
City 1_z�rai -_- - -- c6 -1 1 State Zip I ---ctiR_L, TelephoneF_
Last
Applicant's Address
. . . .. ...... .... ......... ...
city State
First
Applicant's E-mail Address
Zip Telephone
ARCHITECT/DESIGNER'S NAME Last I- First F_ Lic. No. F-7—
Architect/Designer's Address
-------- -- ----------_----_-
State S
city 1 7
Architect/Designer's E-mail Address
Zip Telephone[ ----,.,--.,--
ENGINEER'S NAME . Last [ First F777777 Lic. No. F___
Engineer's Address
Cit y State
CONTRACTOWS NAME/COMPANY
Contractor's Address
City[ State
SETBACKS REAR SETBACKS FRONT
Engineers E-mail Address
- - _ __ ------ -- -- -------- ---- --
zip F—Telephonel-
Lic. No. ly �U, Class
I F
Contractor's E-mail Address —
P4�) ;Jybk; 62 DAIJ�IIYW4�6 o, -N
Zip Telephone C` el j 5qf - Tit?
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. Q62j , !q