HomeMy WebLinkAboutX2021-0762 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit A lication o4 " °Rra
j- Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTO -
F_ Building F_ Grading Wrainage Dt Elec F_ Mech
C Plum Cu vd Cut Cu Yd Fill F
Project Address (Not mailing address) F_ Flood F_ Fire j` Liq j- Landslide F_N/A Floor Suite No
Z2.t If.
Description of Work
Use F—Const Type F_
Stories # Units (if Res)[—
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New/Add SFF— Remodel SF Garage/New/Add F
Valuation $
Material/Labor
OWNER'S NAME Last �;�dN —
]U�
First
Owner's Address
Owner's E-mail Address
22 Tru-.a j� \\2.
City NeW eov- -- State �
Zip I_— Telephone �t •� s),3S- _ 13•�-2.
APPLICANT'S NAME Last y
First SGN0Innr,,
Applicant's Address
Applicant's E-mail Address
2.10Z't vio, SOlor��.
oGPcrmii�bixv�ul��r+���k.
City cJ ours G`�,� State �
Zip -7 W-7 3 Telephone 7 g l'Z,-OS'9 S'
ARCHITECT/DESIGNER'S NAME Last
First �� Lic. No.
Architect/Designer's Address
Architect/Designers E-mail Address
City State m
Zip F Telephone��
ENGINEER'S NAME Last
First Lic. No.�
Engineer's Address
Engineer's E-mail Address
City I State
Zip F_ Telephone��
CONTRACTOR'S NAME/COMPANY S� G� C ohctPF S Lic No. rj;g� Z Class L_Z
Contractor's Address
Contractor's E-mail Address
I1a.37'Z- w �- auilt7
City Iy,.V�State C_(�-
Zip �i'ZL,, OlQ Telephone 1'r9 (oS'3-) I O )
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SETBACKS REAR SETBACKS FRONT
PERMIT NO. Y° v
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. TA
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $ V `