HomeMy WebLinkAboutX2021-2538 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application o^ EWER>e
F_ Comm'I PZBesidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIMF (-)F si iRnniTTni
xBuilding F_Grading r`Drainage rElec (—Mech F—Plum Cu Yd cut Cu Yd Fill
Project Address (Not mailing address) f Flood r Fire F Liq r Landslide F_N/A Floor Suite No
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Description of Work
Use ConstType I
R67FPJWY Ve'V � �NLrrPL'. ALP �hnl� s/ /J+c✓ ZZc>c9/7 To
# Stories# Units (if Res)F
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Valuation $
Material/Labor
New/Add SF /I)^ Remodel SF jtr :' Garage/New/Add �—
OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
City A122w'-''=f PeeA1/' State TA Zip T'�' J TelephoneF_
APPLICANT'S NAME Last WljZTT-Ioiti First
Applicant's Address Applicant's E-mail Address
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City I Lr)5ra V, rc].,N State (-W Zip ��(;G� Telephone[
ARCHITECT/DESIGNER'S NAME Last W 1 Zrrq};7 / First l—
c'FI )?L11 Lic. No. til�k
Architect/Designer's Address Architect/Designer's E-mail Address
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7;' L%ASr )7n, ai - IEIL?L.k j VL i A14,s/�
City State C Zi ' 27 p �—
p %`� , Tele hone
ENGINEER'S NAME Last F E j
S%ems First i , Lic. No. , �?
Engineer's Address Engineer's E-mail Address
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City ��i�� Y�'i ?� J'�t �L� State ll Zip �2L;� i TelephoneF
CONTRACTOR'S NAME/COMPANY j r r Lic. No. -`�� 1 Class 17
Contractor's Address Contractor's E-mail Address &T_73ocn-) I-
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City State F 7� ZiP ! . S �, Telephone t'
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. /
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $