HomeMy WebLinkAboutX2021-2833 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application
f- Comm'I F_ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building Grading F-Drainage F_Elec F_Mech FPlum CuvdCut CurdHIF
Project Address (Not mailing address) I— Flood F_ Fire r Liq r- Landslide FN/A Floor Suite No
Description of Work
Use F Const Type F
# Stories # Units (if Res)
Valuation $
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New/Add S�— Remodel SF� Garage/New/Add
Material/Laborer O0 p
OWNER'S NAME Last �/S�v First h9� L
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Owners Address Owner's E-mail Address
City F y, /%ciC> State Cg Zip ,? (6 Ct Telephone o[ g- gG7l�7L
APPLICANT'S NAME Last G�oujeAlf First P9u
Applicant's Address Applicant's E-mail Address
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City yD State C: Zip .261j l] Telephone IP/9—rz
ARCHITECT/DESIGNER'S NAME Last s
/�'C✓Gi First 9i Lic. No.
Architect/Designer's Address Architect/Designees E-mail Address
City I State Zip i Telephone 7/y—gyp_ 6 y/6
ENGINEER'S NAME Last First F— Lic. No.F_
Engineer's Address Engineer's E-mail Address
City State Zip F Telephoned
CONTRACTOR'S NAME/COMPANY GDUS�NJ 7rC Lic. No. S3j683 Class
Contractor's Address Contractor's E-mail Address
City State F_ Zip F__ Telephoned
-,ETBACKS REAR SETBACKS FRONT PERMIT NO.
BACKS LEFT SETBACKS RIGHT PLAN CHECK NO. Z y 7 V _ ZeSL I
1 'DNE DEVELOPMENT NO PLAN CHECK FEES $