HomeMy WebLinkAboutX2021-1793 - Permit Application (3)Print Form I Worksheet for Combo Building & Solar Permit Application
Comm'I F_ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
;uilding F_ Grading F-Drainage r Elec F_ Mech
!'Project
F-PlumCu vd Cut Cu Yd Fill F_
Address (Not mailing address) F_ Flood
F_ Fire F_ Liq r Landslide FN/A Floor Suite No
1371 F
I I
Work
Description off
Use F—Const Type F
2 �/ Q
W
AP> �L J
#Stories #Units (if Res)
New/Add SFF, (� Remodel SFF Garage/New/Add
Valuation $
Material/Labor
OWNER'S NAME Last LU Y�� G3� tr L G First
Owners Address
Owner's E-mail Address
13�7 ppoc VP..
City #9FjPoR� p5Ae State I �� /
Zip Telephone % Ilt- 27L 6
APPLICANT'S NAME Last PeNT
First /Y-fr
Applicant's Address
Applicant's E-mail Address
&l 57•
`d l GaN�
City I�Z/, , A State l,/ J
Zip -, Telephone �i4
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designers Address
Architect/Designers E-mail Address
City State F_
Zip F_Telephoned
ENGINEER'S NAME Last
First F Lic. Nou Zt�—
Engineers Address
Engineers E-mail Address
City State F___
Zip F Telephoned
CONTRACTOR'S NAME/COMPANY CGL�SS fi,
jM Lic No. �I 91assI
l ✓
Contractors Address
Contractors E-mail Address
�j2Zz� p'?f ftD f_jjv
City (/ V ltqL- State I `-
Zip Fq Z 61 & Telephone <� I 3 �0 3 7i3
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
0
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
t
PLAN CHECK FEES $ J/tV