HomeMy WebLinkAboutX2021-2617 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application ,-`WPo'm
omm'I �sidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL c�'a,.'
r�6ilding r Grading F-Drainage r Elec i- Mech r Plum CuvdCut F CuYdFill
Project Address (Not mailing address) i_ Flood f- Fire r Liq r Landslide F_N/A Floor Suite No
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Description of Work p/ / c/It,, c -D //+ d l o
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Us�U Const Type V'�
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# Stories # Units (if Res) //4p
GUA-6teS A,Uf� Cry/G/itl�i/%�a+N /3/N`a'i' AS
Valuation$ oc
Material/Labor // Z�'
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New/Add SF L --- / ReadefSF �6 >� Garage/New/Add
OWNER'S NAME Last 1/"r�/V�-- First
Owner's Address Owner's E-mail Address
City f — State F- Zip FJ Telephoned
APPLICANT'S NAME Last /12--0,4 x First
Applicant's Address Applicant's E-mail Address
city L Q( 1 State _A Zip Telephone 9yf7- ZgL�-cam.
ARCHITECT/DESIGNER'S NAME Last First First ! _,471JD)/ Lic. No. .' 7 7Zg�_
Architect/Designer's Address ArchitecUDesigner's E-mail Address
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City r.- State...,. -Zip Telephonel4
ENGINEER'S NAME Last F First F— Lic. No.F_
Engineer's Address Engineer's E-mail Address
City �— State � � Zip F— TelephoneF_
CONTRACTOR'S NAME/COMPANY Lic. No. 'ps Class
Contractor's Address Contractor's E-mail Address
City I— State �- Zip F_ Telephoner
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SETBACKS REAR SETBACKS FRONT PERMIT NO. X LZ Z � — Z V 1
1
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. Z 17
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $