HomeMy WebLinkAboutX2021-1682 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar P M& plicaliO�?""°
City of Newport Beach - Building Division
F_ Comm'I Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL G<"a„.•'
F_ Building r- Grading (Drainage F_Elec j-Mech (-Plum CuvdCut CuvdFill
Project Address (Not mailing address) F_ Flood F- Fire F== Liq r••` Landslide r_N/A�Floorr Suite No
Description of Work
Use iE2 Const Type F_
rceiol'r wlftl< W4/r AD F ory Wya//
# Stories # Units (if Res)
F------
New/Add SF Remodel SF Oji
Gara a/New/Add
g
Valuation a 6 Q pd
Material/Labor /
OWNER'S Last _ VK4,4
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Owner's Address
Owner's E-mail Address'
city LWI�E Euj�kOf�' State Lr'I#' Zip TelephoneF_
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APPLICANT'S NAME Last F 6U&VA,'N t C,
First J o 5 I-/
Applicant's Address
Applicant's E-mail Address
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Zip q,?7; J Telephone °'l+J eZ%'l z2 e/
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ARCHITECT/DESIGNER'S NAME Last
First F_ Lic. No.
Architect/Designees Address
Architect/Designer's E-mail Address
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city C);;:; e State FTA-
zip q2�'} Telephone 1_4 qy�-,j(UlJ
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ENGINEER'S NAME Last fj yet (
First 'add t_ L_(o Lic Noff E 5 _R_
Engineer's Address
Engineer's E-mail Address
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City F ®yLANC,& State Gpc
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CONTRACTOR'S NAME/COMPANY !j/9j+ j9;ryz/v1r4,1y Lic. No. ClassFe
Contractor's Address
Contractor's E-mail Address
City 1_01<6 e_5t40tEF State 6j�
Zip gfj7�rZ. Telephone �5/ Jr7 7zz
SETBACKS REAR SETBACKS FRONT
PERMIT NO. v
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
M p ` V t! PLAN CHECK FEES $