HomeMy WebLinkAboutX2021-0685 - Permit Application.Print Form I brksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division'�7J (j(�
F. Comm'I r Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F,Building ) _; Grading (Drainage ❑ Elec F, Mach [ Plum Cu Yd Cut i Cu Yd Fill
Project Address (Not mailing address) F-, Flood [-: Fire F_ Liq j- Landslide [IN/A Floor suite No
New/Add SF Remodel SF Garag a/New/Add
OWNER'S NAME Last ft i r -C S
First
Owner's Address Owner's E-mail Address
f F.
C;
City r ,_ : I ,- State — Zi Tele hone
- --- -- p P r G !
Use F Const Type
# Stories7 # Units (if Res)
Valuation $
Material/Labor., 1 --
APPLICANTS NAME Last, First k-}
5 z _ _
Applicant's Address
City State (_T\
Applicant's E-mail Address
Zip F77, k L - Telephone ri 71, qf _T
ARCHITECT/DESIGNER'S NAME Last First [7777777777 Lic. No.
Architect/Designer's Address
City - State
Architect/Designer's E-mail Address
— --- _ --- ---- .._._.......__-----
Zip TelephoneF—
ENGINEER'S NAME Last First Lic. No F
Engineer's Address
City State I
Engineer's E-mail Address
Zip �— Telephoned
CONTRACTOR'S NAME/COMPANY l . ' EW k r,_.,, , � Lic No. (c I 'r` j Class c = <<
ti
Contractor's Address
City L i e l t, State C f
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
Contractor's E-mail Address
Zip 1 M f �, Telephone
PERMIT NO. .
PLAN CHECK
USE ZONE DEVELOPMENT NO, :_ PLAN CHECK FEES $
1.