HomeMy WebLinkAboutX2021-1058 - Permit Applicationr'rint Form Worksheet fof Combo Building & Solar Permit Application ON
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F_ Comm I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAI.
Building )-�ading rKrainage XElec F?I ech r�lum Cu Yd cut 4 Cu yd Fill I + �3
Project Address (Not mailing address) I- Flood F- ;Fire C Li, r Landslide F_N/A Floor Suite No
Description of Work
Use�ConstType I ' " 5
te&BSI I' 7' I
# Stories # Units (if Resf
Valuatio $
Material/Labor
ew ��
Add SF Remodel SF Garag(fee f/Add I l !
OWNER'S NAME Last �is � A �r
First �JN,
Owner's
Address
Owner's E-mail Address
City f, A- State I ` Zip Telephone
APPLICANT'S NAME Last l J(J o Firsts � r" - _ 1`�
1
Applicant's Address Applicant's E-mail Address
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v 't.J-v f J Cam- V t %
City �l I State Zip Telephone
ARCHITECT SIGNE NAME Last yl First I � � j AAn
V\-/ w,� L Lic. No.
Architect/Designees Address Architect/Designees E-mail Address
City State I _—v- -' Zip � �— Telephone
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ENGINEER'S NAME Last t`/1 r,5N_ '1 First F��(_ Lic.NoGJF t/-o�i-�
Engineer's Address Eng'eer's E-mail Address
City tV^_a /t_ State (�-t Zip �Z Telephone 7I
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CONTRACTOR75(NAM►E�/1C/O�MPANY `'` 0. Lic No. PhvlassF
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Contractor's Address Contractor's E-mail Address
City I State �— Zip F TelephoneF_
SETBACKS REAR v SETBACKS FRONT PERMIT NO. ��Q2� g
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. DMZ - z- ZeSU�
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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