HomeMy WebLinkAboutX2021-3168 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
(- Comm'I F- Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding (Grading rDrainage F_Elec j-Mech rPlum Cu Yd Cutl Cu Yd Fill
Project Address (Not mailing address) r Flood r Fire (- Liq F_ Landslide ! N/A Floor Suite No
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Description of Work
Use I ConstType F
# Stories # Units (if Res)7
Valuation $
Material/Labor I S00
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New/Add SFRemodel SF{ '�� 1
Garage/New/Add
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OWNER'S NAME Last N 1 _Iq f P�Q` G (�) =5 ( First i
Owner's Address H O IrN
Owners E-mail Address
"1r0 i Nit -Fi S
City State
Zip 'j TelephoneF
APPLICANT'S NAME Last .Sm l 1 t4
First NG-tJS
Applicants Address
Applicants E-mail Address
1 13 4-- NL 0" '
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City S �r ('�State /" /1
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Zip 9 ` oa Telephone
ARCHITECT/DESIGNER'S NAME Last!
First Lic. No.
ArchitecUDesigners Address
Architect(Designers E-mail Address
City State F—
Zip Telephone!
ENGINEER'S NAME Last Xj
First 1 �� {\/ Lic No.'
Engineers Address
Engineers E-mail Address
sad C-N)a(-�4Q,-U ✓ 1� 4s
City �A 1U State
Zip Telephonel�?14
CONTRACTOR'S NAME/COMPANY i IV_(�;rU � ,—Lic.No. � Class!
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Contractors Address
Contractors E-mail Address
N& t n- ?C? e 'we. tit rY
City S0 (\% ` (A (1 N_pr State <f
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Zip �� Telephones, l
SETBACKS REAR SETBACKS FRONT
PERMIT NO.�u
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
I1SF 70NF
DEVELOPMENT NO PLAN CHECK FEES $