HomeMy WebLinkAboutX2021-2637 - Permit Applicationprint Form Worksheet for Combo Building & Solar Permit Application
Comm'I fX Residential City of Newport Beach - Building Division XXz1_ zcoly-_
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
$y�_Building F_ Grading rDrainage [ Elec I— Mech r Plum
Address (Not mailing address) F Flood r Fire [7 Liq F- Landslide
!,.... Cu Yd Fill I -
[N/A Floor
Suite No
Description of Work UseF Const Type vg
# Stories # Units (if Res)F
Valuation $
New/Add SF Remodel Remodel SF �1 Garage/New/Add Material/Labor
OWNER'S NAME Last �� �CL1 First
Owner's Address Owner's E-mail Address
City '. State F Zip F_ Telephoned
APPLICANT'S NAME Last I ��\. VA `/\, First I 64�O(Lv ck r\ -
Applicant's Address Applicant's E-mail Address
Cit \ StateFQ N Zip �(Z:A4:k���4C �2
C) Telephone �\S3
ARCHITECT/DESIGNER'S NAME Last FirstF_
Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State F_— Zip F— Telephoner
ENGINEER'S NAME Last _ _ _ First l Lic No. q z.
Engineer's Address Engineer's E-mail Address
City State I V ` Zip 2J� Telephone 626�o�tz�"
CONTRACTOR'S NAME/COMPANY Pl_Os COQ o< l��.No. 1�3 Class
Contractor's Address ( Contractor's E-mail Address
I�(�
City �1-��� State c Zjp q?50, Telephone 4(A 4S6"Z,(05
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
PERMIT NO. VIA LIQ
PLAN CHECK NO. 1 1 1 V `)
USE ZONE DEVELOPMENT NO M1 i- 01A I U PLAN CHECK FEES $