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HomeMy WebLinkAboutS2021-0172 - Permit Application (3)Print Form i Worksheet for Combo Building & Solar Permit kpp ica iort `" Comm'I F- Residential City of Newport Beach - Building Division %� ,� NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL ! C �Qw (Building F_ Grading F -Drainage F_ Elec [_ Mech F- Plum Cu Yd Cut F_CA F Project Address (Not mailing address) r- Flood F_ Fire [_ Liq r- Landslide F_N/A Floor Suite No �45-j o27J a wAl, g . a %2662 _ Description of Work Use F_ Const Type #Stories #Units(ifRes)[— s� _ 8L�(i!L(' /wsr/yV�x n J/1 /�IL�I�fC�C�7P�-- L✓,%�/J -202 y Valuation ' S Coo Material/Labor New/Add SF Remodel SF P Garage/New/Add r-- - -', Z ZJ�c/ OWNER'S NAME Last I `c%i JT% oc SCi� Owner's Address 2- 001 _1/st "t Owner's E-mail Address City �1�LG✓('vFr � _ State Zip % 63 Telephone �/ �l" dol©` 7200 APPLICANT'S NAME Last e�'Jr�_ c g0 /�Gh (� First Applicant's Address 2-bolapp-a-Applicant's E-mail Address ''I/SG. City �J{r State ' �n ',, zip clzii,f� Telephone Ii/c/ -/0- -7200 / ARCHITECT/DESIGNER'S NAME Last First F Lic. No. Architect/Designer's Address Architect/Designer's E-mail Address City.. _ State F_Zip F_ Telephone F___._-_--_. _ ENGINEER'S NAME Last F First Lic. No.� - Engineer's Address Engineer's E-mail Address City F_ State F Zip �-_ ', Telephoned CONTRACTOR'S NAME/COMPANY Lic. No. F Class Contractor's Address Contractor's E-mail Address City State F Zip F - - Telephone SETBACKS REAR SETBACKS FRONT PERMIT NO. SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. USE ZONE DEVELOPMENT NO PLAN CHECK FEES $