HomeMy WebLinkAboutX2021-2402 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application Comm'I Residential V
r City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUF AT TIMF nF Cl lannllTAl
r-Building F_Grading r-Drainage F_Elec j-Mech I - Plum Cu Yd Cuts Cu Yd FillF_
Project Address (Not mailing address) F Flood j- Fire j- Liq r- Landslide F_N/A Floor Suite No
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Description of Work
Use F—Const Type
2i OUO 2,q�Y�iI dt
# Stories # Units (if Res)s-
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Valuation $
Material/Labor
New/Add SFs— Remodel SFF — Garage/New/Add i
OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
City Q (jlf ,(_y� State FE;F Zip F" Telephone -
APPLICANT'S NAME Last 5�;t V(nk First 0
Applicant's Address Applicant's E-mail Address
City j eVw:C,JVA State + y- P % Lo�� P c5 c U _
Zi �— Tele hone 1-676-U
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ARCHITECT/DESIGNER'S NAME Last First —
Lic. No. �—
Architect/Designer's Address ArchitecVDesigner's E-mail Address
City State �— Zips Telephones--
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ENGINEER'S NAME Last � First i f r7 Lic. No.
Engineer's Address Engineer's E-mail Address " I wI J
City State F— Zip �— Telephoned ---
CONTRACTOR'S NAME/COMPANY, Ip L� 15 0 �1� No Class
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Contractor's Address Contractor's E-mail Address
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City Ie� State Zip Telephone G
SE A S REAR SETBACKS FRONT PERMIT NO.
SE S L � T SETBACKS RIGHT PLAN CHECK N0.�
US ON DEVELOPMENT NO PLAN CHECK FEES $
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