HomeMy WebLinkAboutX2021-1028 - Permit Applicationz-. Worksheet for Combo Building & Solar Permit Application
❑ Comm'I AResidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
❑Building ❑ Grading [-]Drainage ❑Elec ❑Mech ❑Plum CuvdCut= CuYdFill F7
Address
❑ Flood ❑ Fire ❑ Liq ❑ Landslide ❑N/A
Description of work
H/W4!30NS/��✓•i►9 L
New/Add SF Remodel SF Garage/New/Add wl i /4—
Floor Suite No
Use FAW ConstType
# Units (if
OWNER'S NAME Last First I S12o
Owner's Address - Owner's E-mail Address
G •f. 5 2
City D State ® Zip��� Teleph'' one l.p)�`(��.. 9•fl�
APPLICANT'S NAME Last I 45anii4tycFirst 6025 �,
Applicant's Address
-.S O O
city ezo State
Applicant's E-mail Address
1 �Gf/i7z�iT �►Hm.
Zip 2,(�s' Phon o� 27�3
ARCHITECT/DESIGNER'S NAME Last I A3First
Lic. No.
Architect/Designer's Address
City State
Architect/Designer's E-mail Address
Zip Telephoned
ENGINEER'S NAME Last �tOuF First ,��-M Lic. No. G z
Engineer's Address
1.1 r r f-C/ % ^�
City 1M AI State
Engineer's E-mail Address
n►i(�Mic%Si(�
Zip ! 3 Telephone �+ �8 Qs —
CONTRACTOR'S NAMEICOMPANY Lic. No. LI Class
Contractor's Address
City State
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
Contractor's E-mail Address
Zip Telephoned .
PERMITNO. k ozZ — lat
PLAN CHECK NO. D 3 -
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $