HomeMy WebLinkAboutX2021-2560 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application F2£WPORT
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F_ Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building [_ Grading r—Drainage r Elec r— Mech
F— Plum Cu Yd Cut Cu Yd Fill F_
Project Address (Not mailing address) F_ Flood
F_ Fire i— Liq r Landslide F_N/A Floor Suite No
Description of Work
Use Const Type
# Storiesi # Units (if Res)
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eluation $ �`7 ` 5
erial/L or g� gtriy x,S
New/Add SF Remodel SF Garage/New/Add
F
OWNER'S NAME Last J S't�-�
First
Owner's Address
Owner's E-mail Address
State C.��
city � iL- �'{ f (�
Zip Telephone %
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APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
J 'l. �L 1 �V� c, � j 3�t [ 't 14-11 .- C'(,
City State Cir Zip Gi•G( `(� Telephone v '!
ARCHITECT/DESIGNER'S NAME Last ��,�L-, Z_- First Lic. No. �—
Architect/Designer's Address
Architect/Designer's E-mail Addressr
(I (J i
City.t� State C�
Zip "l%L(�;Ct { `' Telephone ''rt C11L
ENGINEER'S NAME Last
First Lic. No.F
Engineer's Address
Engineer's E-mail Address
City State F__
Zip F TelephoneF_
CONTRACTOR'S NAME/COMPANY.'Yk >
(L(. _ kl l,l Lic. No. - �'�J/`_ Class
Contractor's Address
Contractor's E-mail Address
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City t! /'::',! ��. (�- iq: c, n State V- / -
Zip C (2 � �ZE, ' Telephone . }, t /k' � 6, / -&.1
SETBACKS REAR SETBACKS FRONT
PERMIT NO. ZQ — 05
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
1 i
USE ZONE DEVELOPMENT NO t✓—0' S �G l 3PLAN CHECK FEES $