HomeMy WebLinkAboutX2021-3126 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application o EW�arm
City of Newport Beach - Building Division
j Comm'I Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL o
rBuilding F_ Grading (`Drainage F_ Elec f- Mech F- Plum CuvdCut CuYdFill
Project Address (Not mailing address) F_ Flood f- Fire r Liq (- Landslide rN/A Floor Suite No
Description of Work
Use F—ConstType F—
# Stories # Units (if Res)SW
'�
New/Add SF F_Remodel SFF Garage/New/Add
Valuation $
Material/LaborFlqigoo-oo
OWNER'S NAME Last First
I l.Q"'J`
Owner's Address Owner's E-mail Address
L 9� j��c c1 joS)i ive i Y!!� G) s �O taLof c11�'7
City ,.L,rSC, 1. o State I �n zip[ TelephoneF/56/CJ 5792
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
City � j State � Zip l? 7L Telephone ,�jlb �� �! ��
ARCHITECT/DESIGNER'S NAME Last FirstF_ Lic No.
Architect/Designer's Address Architect/Designers E-mail Address
City � State �- Zip TelephoneF_
ENGINEER'S NAME Last ��X J( First I 1�.bG1�jo Lic. No. Z
Engineer's Address?,fa Engineer's E-mail Address
City Y'- L-t b(-L.)7 State ICE Zip l44 OO Telephone
CONTRACTOR'S NAME/COMPANY Lic. No. ClassF
Contractor's Address Contractor's E-mail Address
City � State I Zip I Telephoned
SETBACKS REAR SETBACKS FRONT PERMIT NO. /� i0�' as
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. t, 7 O 19• IOU
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $