HomeMy WebLinkAboutX2021-1446 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit catioquo
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City of Newport Beach -Building Division 4y� y
(- comm" esidential ' NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMI AL
F ulid Ing Grading F_...Drainage r, Elec r, Mech F -Plum Cu Ydcutli Cu Yd Fill
Project Address (Not mailing address) f— Flood r Fire F_ Liq F- Landslide ❑N/A Floor Suite No
Description of Work
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Use � Const Type I v jr�
# Stori��ies��VlllIT # Units (if Res)FT
Valuation $ o -u
Material/Labor r068
New/AddSF- ---� !, Remodel SF rGarage/New/Add I
Last , First
OWNER'S NAME s Ii�v l/
Owner's Address Owner's E-mail Address
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City � �Id��- �V�/ State I Z/^ Zip 2 � Telephoned
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APPLICANT'S NAME
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Applicant's Address Applicant's E-mail Address
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City q� ` '_' ` ... _: State � Zip J Q�_ Telephone a _ �%i?i �74�
ARCHITECT/DESIGNER'S NAME
Last First __. Lic. No.-`��.9•p
Architect/Designer's Address ArchitecUDesigner's E-mail Address
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City IR�1/YL I!� State F< Zip �/ � 7 Telephone''r (•�l/(•
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ENGINEER'S NAME Last t I Lic. No.r
Engineer's Address Engineer's E-mail Address
City _ State F— Zip F_— TelephoneF_
CONTRACTOR'S NAME/COMPANY �/'fw�Lic. No. Fq'q4 Class
Contractor's Address Contractor's E-mail Address
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city State Zip _ �. Telephone qz-D, , 027277�
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SETBACKS REAR SETBACKS FRONT PERMIT NO. �,Qv • '�p
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. Iti(p�Q.2o2I
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $