HomeMy WebLinkAboutX2021-0964 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application aq,
F- Comm'I �tesidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building Grading r`Drainage F_ Elec r Mech F_
r Plum CuYdCut CuYdFill
Project Address (Not mailing address) loo
F_ Fire r` Liq r Landslide rN/A Floor Suite No
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Description of Work
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# StoriesrZ # Units (if Res)F
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Valuation $
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Material/Labor UV�
New/Add SFr'--"-----
RemodelSFF—
Garage/New/AddF—
OWNER'S NAME A
Last
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Ow�Address
Owner's E-mail Address
erner's
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City
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Zip �� Telephone T�L/ j71 ._�, -��
APPLICANT'S NAME Last
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First
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Applicant's Address
Applicant's E-mail Addres�3ll
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Zip U�/ / ,.,ZG� Telephone LI /
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ARCHITECT/DESIGNER'S NAME Last T,,//�` — "
��, l i�1 \ �' (I'jl �� ( f L� Lic. No. r...---------
ArchitecVDesigner's�Address 'ArchitecUDesignertsEmail Address
City IQj State. (
Zip ZC�; Telephone
ENGINEER'S NAME Last .rty�
1
First �r,,�.L Ui; /., Lic. No. E 3"72La'
Engineer's Address
Engineer's E-mail Address
City ��C IGtI i State �.-}�
Zip �') /c>2 Telephone)
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CONTRACTOR'S NAME/COMPANY _ Lic No. �� Class�—
Contractor's Address
Contractor's E-mail Address
City F_ State �_
Zip �— Telephone[
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. I J `. '; '
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $