HomeMy WebLinkAboutX2021-1994 - Permit Application (2)Print Form Worksheet for Combo Building & Solar Permit Application
F?�«�ae
(— Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL 4„0a��'
Building F_ Grading
rDrainage F_Elec rMech F-PlumCuvdCut F CuvdFill
Project Address (Not mailing address) F_ Flood F- Fire r- F- Landslide FN/A Floor Suite No
I's Eu ,,
pLiq
PY , I I
Description of Work
Use F—Const Type F_
11-f�
�Ji.�((w�rYt ��,00eur
# Stories' # Units (if Res)[—
Valuation $
Material/Labor F20!
New/Add SFF
Remodel SF 'gip _40- Garage/New/Add �^F
OWNER'S NAME
Last l YtilO V( Firstar
Owner's Address
Owner's E-mail Address
City
_ State Zip '1265.1 Telephoned
APPLICANT'S NAME
Last First S
Applicant's Address
Applicant's E-mail Address
City G*, 6-ke,�zx
State CZip - LI 2,(v Telephone 11K 732 5256 - - -
ARCHITECT/DESIGNER'S NAME Last�� >t First V iC Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
Cir
City CPb6, *.e atN
State 5; . Zip Cj �GuO _ Telephone I R -j 92-
2ENGINEER'S
ENGINEER'SNAME
Last First F Y1wtq�- Lic. No.
Engineer's Address
Engineer's E-mail Address 7678 1
3rxa0 �j,rJln 5 �f\(� C Ve; kv uL,�o r^01
City I (�,eA
State Zip walt Telephone Fqoq-56q-1,%,;6C
CONTRACTOR'S NAME/COMPANY /1 C `� -, \\ es S Lic. No. Fos goGo Class
lJ•
C'ontractor's Address
Contractor's E-mail Address
City
_._ State zip .—'.. Telephoned—'.
SETBACKS REAR
SETBACKS FRONT PERMIT NO. — f.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. '7 q
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $