HomeMy WebLinkAboutX2021-1691 - Permit Application (4)Print Form Worksheet for Combo Building & Solar Permit Application og
F_Comm'I V Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
(Building OF Grading rjDrainage (—IElec P Mech
F— plum CuvdCut F CuvdFill F
Project Address (Not mailing address) F_ Flood
f Fire r Liq F_ Landslide OtN/A Floor Suite No
Description of Work
use F_F� ConstType ✓-%
# Stories # Units (if Res)[ 7
4 9d se i,&JT
New/Add SF / ' -t i ti,' of'bli / Remodel SF Garage/New/Add p
Valuation $
Material/Labor
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OWNER'S NAME Last (� w'A LYiy't /
First L p ? j L
Owner's Address
Owner's E-mail Address
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City C D fyState ^
Zip �-' 1 z ` "j S Telephone 4 9) -z 9 - S ti: (c j
APPLICANT'S NAME Last %� / < C hj
First y �_, / C,
Applicant's Address
Applicant's E-mail Address
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'�7I'�,CT �,/ CI E
L (l� �_ �`-1 �t�/ �y
-iC
City I c State /1
Zip cj Z 72S Telephone 'jar �f > %-7
ARCHITECT/DESIGNER'S NAME Last. C C First— Lic. No.
Architect/Designer's Address
ArchitecUDesigner's E-mail Address
City State F_
Zip �— Telephone F
ENGINEER'S NAME Last Fof�oGj
First Lic.No.C-�i"�
1
Engineer's Address -
Engineer's E-mail Address
E 1��t. 5"T.� �)N1 1
r-lnl -' ; ��it�C' . c
City 5?. j,rA I�f„N State /'A.
Zip rf�_ � � � Telephone��
CONTRACTOR'S NAME/COMPANY —�--� .�
Lic No. F Class F
Contractor's Address
Contractor's E-mail Address
City � State F_
Zip Telephoned
SETBACKS REAR SETBACKS FRONT
PERMIT NO. V
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $