HomeMy WebLinkAboutPV2021-020 - Permit ApplicationL — Print Form J Worksheet for Combo Building &'Solar Peinllit Application 1101V
City of Newport Beach - Building Division
Ft,Comm'l F—Ve'sidential
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
V'ullding F Grading f—Drainage F_ Elec F Mech Plum Cu Yd Cut Cu Yd Fill F
Project Address (Not mailing address) F_ Flood F_ Fire F7 Liq F_ Landslide F_N/A Floor Suite No
Description of Work
1r_7g1,V /3 ivy
New/Add SF I Remodel SF
Use Const Type
F77,,
Stories [T,__ # Units (if Res)[/;�
1A15
Valuation $
Garage/New/AddF--7 Material/Labor
OWNER'S NAME Last First
Owner's Address Owner's E-mail Acldresg-_����
City State Zip[—_ Telephonel__________—
.. . ......... .. ..
Iszo-,r,
Last 712_t�l
APPLICANT'S NAME LFirst
Applicant's Address Applicant's E-mail Address
A/5/4��-" A
-- -_ -------
City 154, A D State T� Zip Telephone 9
ARCHITECT/DESIGNER'S NAME
Last First[/ Lic. NcC-__
Architect/Designer's Address qq Architect/Designer's E-mail Address
/A
------------- City State Telephone
ENGINEER'S NAME Last First Lic. No.1
Engineer's Address Engineer's E-mail Address
City State Zip Telephone
CONTRACTOR'S NAME/COMPANY
Contractor's Address
city I
SETBACKS REAR
SETBACKS LEFT
USE ZONE
Lic. No. Class
Contractor's E-mail Address
State Zip Telephone F_
SETBACKS FRONT
SETBACKS RIGHT
DEVELOPMENT NO
PERMIT NO,
PLAN CHECK NO. �)C_ZCPI
PLAN CHECK FEES $