HomeMy WebLinkAboutX2021-2754 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application �EWPoq.
F— Comm'I F- Residential City of Newport Beach - Building Division g
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
r Building F— Grading F—Drainage F—Elec F—Mech
v
FS Plum Cu Yd Cut Cu Yd Fill F
Project Address (Not mailing address) F- Flood F— Fire F- Liq F— Landslide FN/A Floor Suite No
F_ I
a a 7 100-c-r �zs-74 c
Description of Work
Use F_ Const Type
(3 t//E�<
# StoriesF_ # Units (if Res)[_
Valuation $
Material/Labor J S00
New/Add SF —Remodel SFFGarage/New/Add
OWNER'S NAME Last „/f/iJ
First .FfH/a'C� l,✓
Owner's Address
Owner's E-mail Address
02 07 C/ /1J2 % /� t il7ia
g v� . �4sii7 0
City Fr5?e4c5 State �—
Zip _e� 0 Telephone gt/t?
APPLICANT'S NAME Last G o U S Cn- f
First 1 ,�J r, (
Applicant's Address
Applicant's E-mail Address
/9y3 ,5Z)A7 7.0L,/- .61 C,�
CC) U1C.�}C-)A,»1rQ(_11FOt.a
City y/� State CA
Zip QZ ,(G Telephone
ARCHITECT/DESIGNER'S NAME /
Last First Zt,�7 Lic. No. �✓I
Architect/Designer's Address
Architect/Designees E-mail Address
75 6 �-/ >~„N kl-( e
City �( , C �o State �—
r ;-3,
Zip p,S�
� aTelephone
ENGINEER'S NAME Last /
>/U J 2C 2
First /� 3 Lic. No. 3sS.r
Engineer's Address
Engineer's E-mail Address
City State r
Zip /(2 GZ J Telephone %y_ SSNaj/(
CONTRACTOR'S NAME/COMPANY C o USCi�1 C °�J 7./ Lic No. �S 6 Class�p
Contractor's Address
Contractor's E-mail Address
City State
Zip F Telephoned
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. r
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $