HomeMy WebLinkAboutX2021-2992 - Permit Application_Print_Porm_j Worksheet for Combo Building & Solar Permit Application
Comm'l Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
,L,,,building F_ Grading F_-Drainage F,,Erec {r`Mech f-�Pium
Project Address
i
of Work
New/Add SF
-- Cu Yd Cut I Cu Yd Fill I
(Not mailing address) [ Flood r Fire [ Liq [ Landslide rN/A
Floor Suite No
Use Const Type
TCiV1IG I /iJ�S�F✓ JJi.3S7�i
f�Z - J I#Stes� �Units (if Res)
11 ._.- ._.__—.. - - -
Remodel SF Garage/New/Add
OWNER'S NAME Last ��LcJCt%A ` First
Owner's Address -
Owner's E-mail Address
12
' iJLJ�C.v At
City State F�
ZIP C11 %L 7 -�, T�
APPLICANT'S NAME Last -F _. _ .-__ - - -
Applicant's Address
Applicant's E-mail Address
$ J
abor
City State , [J�Zip —�jlephone
ARCHITECT/DESIGNER'S NAME
Last 13
First
- -- Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
Zip Telephone
City State
ENGINEER'S NAME Last �®
First �— Lic. No.F�
Engineer's Address Engineer's E-mail Address
City State r
___--- Zip I Telephoned
CONTRACTOR'S NAME/COMPANY No.7�/U(J
Y J Classl
Contractor's Address -
Contractor's E-mail Address
city - -- -- _
State C%4Z� Zip Telephone <� �234 l'��
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT
USE ZONE
SETBACKS RIGHT
DEVELOPMENT NO
PERMIT NO. 2fl 2A
PLAN CHECK N0.
PLAN CHECK FEES $