HomeMy WebLinkAboutX2021-2963 - Permit ApplicationPrint Form -1 Worksheet for Combo Building & Solar Permit Application
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F Comm'I Residential City of Newport Beach - Building Division X204 - 2cw� I
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
1713ulding [Grading Drainage lec Mech Plum Cu Yd Cut Cu Yd Fill
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Project Address (Not mailing address) r- Flood r- Fire F-, Liq F_ Landslide F -,N/A Floor Suite No
903 Wir
Description of Work
Use Const Type
StoriesF1 # Units (if Res) F--
- - - ------- - -
Valuation $
Material/Labor ii?00
New/Add SFF------ Remodel SF 7)0- Garage/New/AddF7777
OWNER'S NAME Last First ._ _
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Owner's Address Owner's E-mail Address
_�ilii State F
City zip Telephone (s --YT C3
APPLICANT'S NAME LastFirst
L N dkq_P�1_ -_ -_ ___
Applicant's Address Applicant's E-mail Address
City State Zip Telephone! C71_4)3A6 Y�
ARCHITECT/DESIGNER'S NAME Last First F77777 Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
State
City zip TelephoneF77777
ENGINEER'S NAME Last First F77777 Lic. No.
Engineers Address Engineer's E-mail Address
- - - -- , ____ L_ _ - - ---
City ----- -- State F_7 ZIP TelephoneF
CONTRACTOR'S NAME/COMPANY CC4 �1^40L Sb KStok1jej c. No. Class[
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Contractor's Address Contractors E-mail Address
City 1, State FtA__ Zip q0_ Telephone F
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SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO, �-547
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $ 7
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