HomeMy WebLinkAboutX2021-1691 - Permit Application (5)Print Form Worksheet for Combo Building & Solar Permit Application Q
City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL Comm'I 7 Residential
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j—/Plum Cu vd Cut Cu Yd Fill %r
Project Address (Not mailing address) F Flo o
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Description of Work
Use Const Type I v J/J
it StoriesFT # Units (if Res)T j
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Valuation$
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New/Add , �� < orf I i Remodel SF Garage/New/Cd�/o//')Material/Labor
OWNER'S NAME Last
First 1 `JJjcP,
Owners Address
Owner's E-mail Address
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City D 7Y� , State Jt"
Zip -' 'z vj 5 Telephone 4 C) . 2 ��- 5 C, (C' j
APPLICANT'S NAME Last i)`' S fig%
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First' /C
Applicant's Address
Applicant's E-mail Address
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City 7� Iv! State C/i
ZiiL 67 1, Telephone Ft� f
ARCHITECT/DESIGNER'S NAME ,� i, ;; Chl
Last
First % LicNot - ;4{- i m
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Architect/Designer's Address
ArchitecUDesigner's E-mail Address
City State ��
Zip F_ Telephoned
ENGINEER'S NAME Last I F or-13c3
First PPS L i- Lic No. L 3c_�i"tZ
Engineers Address
Engineer's E-mail Address
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City I 5%+N % A HA,H State FA
Zip 1.1 r j Telephoned
CONTRACTOR'S NAME/COMPANY
Lic No. w I V 7 7 Class
Contractor's Address_
Contractor's E-mail Address
City ,- y� ,. State [
Zip ' i Telephone `) yi ;o 2,1 } „ ,,o
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SETBACKS REAR SETBACKS FRONT
PERMIT NO. •{,
SETBACKS LEFT SETBACKS RIGHT
PLAN CW CK NO.
USE ZONE DEVELOPMENT NO
_ PLAN CHECK FEES $