HomeMy WebLinkAboutX2021-1873 - Permit Application__. PrU t _ForiW71 Worksheet for Combo Building & Solar Permit Application
I Comm'I ❑ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building ❑Grading []Drainage ❑Elec ❑Meth []plum cuydcutn CuYdFill F
Project Address (Not mailing address) ❑ Flood ❑ Fire ❑ Liq (I Landslide FIN/A Floor Suite No
Description of Work ✓ Use p onstType l
Grl - u wl��L i aiz o � I ��'��-�
# Stories N Units (if Res)❑
------ ---- -- -
Valuation $ /
New/Add SFF Remodel SF I Garage/New/Add Material/Labor
OWNER'S NAME Last}(,��—��� First
Owner's Address Owner's E-mail Address
O ol4 1 -�
i �� �-��_ �
City ' : V State Zip y I "� Telephone
APPLICANT'S NAME
Last ... �/�,�--- —-I First ------------
Applicant's Address -t - Applicant's E-mail Address
City Q� - L(hj_ State FI _ Zip q Z (Z7 Telephone Z• 77t
ARCHITECT/DESIGNER'S NAME Last _ �� �')7 J First �l(
Architect/Designer's Address
City . �_ �.w/�G�� N51,41 State -U
Lic No. FzTje�h
Architect/Designer's E-mail Address
Zip Z .6 0 Telephone I L
p �T��:I�
ENGINEER'S NAME Last _- _ First �� Lit No.���
Engineer's Address
City _--- State L '
Engineer's E-mail Address
Zip -----
CONTRACTOR'S NAME/COMPANY Q� PMi Lic.No.
5Class�—I
Contractor's Address
City h State
SETBACKSREAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
Contractor's E-mail Address
SG�r-[rye ('-e``N4r✓Kbv�)der5,Gokn
Zip -q_` 6 j g Telephone y y -7t5�j' ; -� ti /-
_
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PLAN CHECK
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $