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HomeMy WebLinkAboutX2021-2684 - Permit Application (2)Print Form Worksheet for Combo Building & Solar Permit Application City of Newport Beach - Building Division 920 r Comm'I F7Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL �� �� F_ Grading Drainage [- Elec r Mech Address (Not mailing address) F, Flood g It6rccj 1 i7'lp 'Plum Cu Yd CutF Cu Yd Fill Fire r Liq r; Landslide J_N/A Floor Suite No Description of Work Use F Const Type F kF41 A W Gzz Cvq v1 # StbriesF_ #Units (if Res) Valuation $ New/Add SF � � Remodel SF F— Garag a/New/Add F—! Material/Labor V OWNER'S NAME Last First Owner's Address Owner's E-mail Address City y1v\, __ State Zip Qf Z lP SZ Telephone I i(0 6 APPLICANT'S NAME Last I A7D (5 0�1 First l AkOL d 1L Applicant's Address Applicant's E-mail Address 16 `i 6 �_rcl ,PC -_-6 n, testa in v_.0 y 6 1 /4Z o �✓�!ro©,c1r�-l. City l V' 1l i J,lz, State I Zip _�i�by_ Telephone 1_LC J? 7 ARCHITECT/DESIGNER'S NAME Last -tQ. First F Lic. No. Architect/Designees Address Architect/Designer's E-mail Address i City State all ZipF Telephone�— ENGINEER'S NAME Last °{– o in so n First 1 rt1 _ ` C Lic. No.F_ Engineer's Address Engineer's E-mail Address City Atskjlli eState Zip dj2 i'() % Telephone 114 b3 . 6160 CONTRACTOR'S NAME/COMPANY tip �OYy C,,S].,,,)CjZ)& Lic No. R/(fg7(,�,. Class �� Contractor's Address Contractor's E-mail Address City l r \/ I njZ_ State I ZW Zip I 6 �� O Telephone ' Z/ 3 7p {o 6 1 SETBACKS REAR SETBACKS FRONT SETBACKS LEFT SETBACKS RIGHT PERMIT NO. PLAN CHECK NO. Z317 -Z Sj USE ZONE DEVELOPMENT NO DWLq- (]u2- Q42A PLAN CHECK FEES $