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HomeMy WebLinkAboutX2021-2353 - Permit Applicationpont Forri, Worksheet for Combo Building & Solar Permit Application F_ Comm'I F;<Residential City of Newport Beach - Building Division X�021-2)53 NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL rBuilding [Grading Drainage (-Flet F_'Mech r Plum cuvdCut F Cu Yd Fill F Project Address (Not mailing address) F_ Flood F_ Fire r Liq Landslide FN/A Floor Suite No Description of Work Uses Const Type 3 rlli -rAfliod1gS (lZMd17r:L 114A(p 4j)171N6 12&CCtf�/7 L # Stories # Units (if Res) Z 5 SValuation $ _. Z New/Add SF1__ Remodel SFF- Garage/New/Add Material/Labor) � OWNER'S NAME Last�.K Y ©/ s c v 1 L GL First l c vlJ Owner's Address Owner's E-mail Address cat-/ City ,VCt�f) # iG G/f State Clf Zip W .-.. Telephone Z — f X " _ iJ 4 APPLICANT'S NAME Last First Applicant's Address Applicant's E-mail Address City State �— zip F Telephone ARCHITECT/DESIGNER'S NAME Last s �j First !�&hH IV Lic. No. Architect/Designees Address Architect/Designer's E-mail Address - q�_ /- ?/�trtNG- G��✓Tck (JK #(Zoo �� �y City ZflT7J State �— Zip . Z-�d Telephone ENGINEER'S NAME Last t First Lic. No.F-- Engineer's Address Engineer's E-mail Address City State s� Zip �— Telephonel— CONTRACTOR'S NAME/COMPANY Lic. No.Ft '- Class Contractor's Address Contractor's E-mail Address c vG�L sZ�,AVZC ��z��asZn pcur:�s2�vT�ol� - City State F Zip r Telephone ( —4 g(4 SETBACKS REAR SETBACKS FRONT PERMIT NO. SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. USE ZONE DEVELOPMENT NO PLAN CHECK FEES $