HomeMy WebLinkAboutPV2021-035 - Permit ApplicationPrint Form ; Worksheet for Combo Building & Solar Permit Application 01,114-mComm'I Residential City of Newport Beach -Building Division��7Se
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL t
F,Building F_Grading j -Drainage F`Elec rMech F -Plum Cu Yd Cut F Cu Yd Fill
Project Address (Not mailing address) r Flood F- Fire F- Liq F_ Landslide F_N/A Floor Suite No
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Description of Work
Use F Const Type F
# Stories #Units (if Res)
Valuations p� - I J2- ,LIQ
Material/Labor
New/Add SF�—', Remodel SF�— Garage/New/Add F—'
OWNER'S NAME Last p`I J� First
Owner's Address Owner's E-mail Address
City State Zip Telephone qT - V
APPLICANT'S NAME Last _ First _ U _CC`
Applicant's Address Applicant's E-mail Address
City State llf l Zip FF2--�-� Telephone c6S7 Taj -1
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State F Zip F TelephoneF
ENGINEER'S NAME Last First �— Lic. No.1
5 "7 Z - C/
Engineer's Address Engineer's E-mail Address
City State r Zip Telephone[
CONTRACTOR'S NAME/COMPANY Lic. No. 1�Class
Contractor's Address Contractor's E-mail Address
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City 1 State Zip Telephone3- ,?j"��-,
SETBACKS REAR SETBACKS FRONT PERMIT NO. W 2� ' per✓'/1
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $