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HomeMy WebLinkAboutX2021-1789 - Permit ApplicationPant Form ` Worksheet for Combo Building & Solar Wn icaati e I- Comm'I Residential City of Newport Beach - Building Di s o NOTE: PLAN CHECK FEES DUE AT TIME O S MITTAL G +•' -�ilding Grading F -Drainage F'Elec F_Mech -Plum CuvdCut [_ CuvdFill F_ Project Address (Not mailing address) F_iFlood Fire j¢— L�iq F_ Landslide FN/A Floor Suite No � /�F� t-7 kl� 1 J t2 v e' T4 P0q ?,?' -n 1 1— Description of Work Use I— Const Type F cvi.m: QL q-� S ueUAW l/Ij- # Staries[— #Units (if Res) Valuation $ Material/Labor r� New/Add SF�' Remodel SF Gara a/New/Add 9 OWNER'S NAME Last t ?igs .TMJ First I I�Fq Owner's E-mail Address Owner's Ad[ddrresss�j p _.o Y�"''°c�'r-� �Q'T/ V.t[/ _. d�i�lgU4i r✓ Q °�-WlG"' ('D'✓(/�' City ... State Zip Z o Teleephone t +`F(o.__ cni APPLICANT'S NAME Last 0 ti l y/ CZ,- First p> lv v v Applicant's Address Applicant's E-mail Address 422 �� h.�7 �cL- 3wb . SfE(od bol : �.� r/ � �v luso • Cam`' City .'. �% '..... State Zip ni`%(Qb0. Telephone q,A C,23 77+s _.... _.... ARCHITECT/DESIGNER'S NAME Last G e—,p a-{ 5 'First SO l -I'1-; Lic. No. Mv Architect/Designer's Address Architect/Designer's E-mail Address City 1 (>, ✓ ..t r/ l State e/�_ Zip 7/&PC> TelephoneRQ6(Wt (,j ()b ENGINEER'S NAME Last First I Lic. No.F_ ( Engineer's Address Engineer's E-mail Address City _.. State F_ Zip I Telephoner CONTRACTOR'S NAME/COMPANY ��GE l hi L i. r1 n t itNo. Class Contractor's Address Contractor`''s E-mail Address lliZUZ c✓vc©'lo �_. City t\�.. �' __.. _..... State G. Zip ���0(i Telephone Re�Z( C(%77_.7/77 4-6 SETBACKS REAR SETBACKS FRONT i PERMIT NO. SETBACKS LEFT SETBACKS RIGHT it PLAN CHECK NO. USE ZONE DEVELOPMENT NO PLAN CHECK FEES $