HomeMy WebLinkAboutX2021-0982 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application zo W�a
r Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
r-Building F_ Grading
rDrainage I- Elec r Mech
r Plum cuvdCut r CuvdFill
Project Address (Not mailing address) [_ Flood [- Fire F- Liq F id e F_N/A Floor Suite No
Description of Work
Use F—ConstType
StoriesF_ # Units (if Res)F—
Valuation
Material/Labor
New/Add SF Remodel SF Garag a/New/AddF_
OWNER'S NAME
Last
First t 1 t
Owner's Address
Owner's E-mail Address
City I l` 1 7b
State F 6E-
Zip 4- Z4 4 ( Telephonel-_
APPLICANT'S NAME
Last F—
First
Applicant's Address _
Applicant's E-mail Address
_.._.. _
City
State
Zip �� Telephoned
ARCHITECT/DESIGNER'S NAME fir -
Last � y � First F �.V-LC- Lic No. F_
Architect/Designer's Address
Architect/Designees E-mail Address
U
ti�, _
4 L "��
City 1 v -6
State OW
Zip � ) Telephone (1 C= `-t
1 aB) r ; `-3cl
ENGINEER'S NAME
Last F—
First r Lic. No. F_
Engineer's Address
Engineer's E-mail Address
City I
State I
Zip F_ Telephoner —
CONTRACTOR'S NAME/COMPANY Lic. No.r� y 2�)lassl p, /
Contractor's Address
Contractor's E-mail Address
vt
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1 r) u0 °v,,i it \ tic;✓(
City Cc?, z: ��. � �� State
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Zip I cif-t"y( elephone 1pt�� �vCl rr 3
SETBACKS REAR
SETBACKS FRONT
PERMIT NO.Z' - Q ISZ
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO. 0 Z(��(
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $