HomeMy WebLinkAboutX2021-2224 - Permit ApplicationPrint Form ) Worksheet for Combo Building & Solar Permit Application
j Comm] Residential
City of Newport Beach - Building Division x2�7,`-222�
( NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL FORNP
Building F_ Grading F-Drainage F_ Elec F_ Mech (— Plum Cu Yd Cut Cu Yd Fill F
Project Address (Not mailing address) F_ Flood F_ Fire j_ Liq F` Landslide [_N/A Floor Suite No
Description of Work
Use Const Type
#Stories #Units (if Res)
TInO
C
Valuation $
Material/Labor
New/Add SF� Remodel SFtC% Garage/New/Add
OWNER'S NAME Last 4kFirst t
Owner's Address Owner's E-mail
,Address
UCH Ov 0V`e-J'vl
City , ` State— Zip Telephone
APPLICANT'S NAME Last � First Gu
Applicant's Address Applicant's E-mail Address
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City � State Zip l2C_ Telephonel zk-� ''�jl� %2 6
ARCHITECT/DESIGNER'S NAME Last j ,�,n --i — First �,Ai.2 Lic. No '
A;�[
Arch itect/Designer's Address �'(� •_ �- Architect/Designer's E-mail Address
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F76
T�
City d State �� Zip C� l TelephoneFT LT2 �3 j
l
ENGINEER'S NAME Last &6PC=-L FI-T-TA First ^-S [-fi?Dt„ Lic. No. :?,,2 ! f
Engineer's Address Engineer's E-mail Address
L_A.J
City Stater Zip 9,6rf y Telephone 2 '
CONTRACTOR'S NAME/COMPANY Lic. No. F Class
Contractor's Address Contractor's E-mail Address
City � State Zip _ Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO. W-1 V L
SETBACKS
LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $