HomeMy WebLinkAboutX2021-2587 - Permit ApplicationRt Fo"rin ; p Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division K?�Z (- 7-
A o g
(-
Comm'I (Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL ( fp Q u i�,�� ioyd F c<'o,.•'
[-Building r Grading r;Drainage [�%Elec FMech (Plum CuvdcutF Cu yd Fill 17
Project Address (Not mailing address) r- Flood F Fire F Liq F Landslide N/A Floor Suite No
Description of Work
Use F - Const Type
FOILtit O �OuP_r y✓l 1 I oqL l ii ° Sad c—�l G rd �n TP,S��(� -
#Stories #Units (if Res)
��
- - _.._... .. --- -
natio $
Material/ or
lo5
New/AddSF� RemodelSF� Gara e/New/Add
_- - - g -®-- '..
... ----...- - ---
OWNER'S NAME Last K� First
Owner's Address Owner's E-mail Address
- 1-i �G� `(•+FFwi (d caws
City /J// - State FZW- Zip Telephone q-11 7
APPLICANT'=NAME Last ` ! Firsta`-App'
Applicant's E-mail Address
City /U State I 67 Zip r -L// / / // Telephone
v�
ARCHITECT/DESIGNER'S NAME Last First (�, Lic. No
Architect/Designees Address Architect/Designer's E-mail Address
p_mI
City n?tvtti { State 7—' Zip Telephone A (o13- aqK
E INEER'S NAM Last l �� First Lic. No. 1
ddress Engineer's E-mail Address
----1� on
City Ui g State G Zip z�z1J Telephone /�/ JV 7y41
CONTRACTOR'S NAME/COMPANY Lic. No. /3gg Classll<
Contractor's Address Contractor's E-mail Address
City 1— State Zip �— Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NOQZP>`i/l 07 7i PLAN CHECK FEES $