HomeMy WebLinkAboutX2021-2564 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application o�EwPoa.
j— Comrn 1 i- Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building j- Grading F-Drainage F_ Elec F_Mech F- Plum Cu vd cut Cu Yd Fill
Project Address (Not mailing address) F_ Flood F_ Fire F_ Liq F_ Landslide FN/A Floor Suite No
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Description of Work
Use F Const Type
Pas5- /2�lC,�4 _ �� caa��.�
# Stories #Units (if Res)
Valuation $
Material/Labor17�CrrU
New/Add SF� Remodel SFF Garage/New/Add
OWNER'S NAME Last a c, v First 3-0 ,5-
Owner's Address Owner's E-mail Address
City State t"2 ZipF2v4 c> TelephoneFT r K-izeY'S 73
APPLICANT'S NAME Fi
rst irst ,`) � v C`
Applicant's Address Applicant's E-mail Address
City State Zip F_ Telephoner—
ARCHITECT/DESIGNER'S NAME Last // /Cm First 7— Lic. No.
Architect/,D/esig�ner'sAddress Z'3 O/LCl �L O Architect/Designer's E-mail Address
-
City (/�rGo f(2gT State L/} Zip Cj z�3V Telephone G7 20 2
ENGINEER'S NAME Last First 7— Lic. No.F—
Engineer's Address Engineer's E-mail Address
City State - Zip F TelephoneF
CONTRACTOR'S NAME/COMPANY -� tit /_03 N,_ Lic. No. ClassF
Contractor's Address Contractor's E-mail Address
City State F— Zip F TelephoneFIt �
X'�- 02 -ZS
SETBACKS REAR SETBACKS FRONT E IT O. /
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. Y
ZONE DEVELOPMENT NO PLAN CHECK FEES $ IV