HomeMy WebLinkAboutX2021-1296 - Permit ApplicationxZozl -1 Z5V
Print Form Worksheet for Combo Building & Solar Permit Application na.,10i
Comm'I residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIMEOFSi iRnniTTni
Building r Grading j Drainage r Elec Mech r Plum Cu Yd CutrCu Yd Fill
Project Address (Not mailing address � Flood r' Fire j-' Liq r- Landslide r•N/A
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Description of Work
UseConst T e
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# Storiesl v #Units (if Res)
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Valuation $'
Material/Laborf�'
New/Add SF[' — Remodel SF
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Garage/New/Add (--- --
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OWNER'S NAME LastZ r
First
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Owner's. Address
Owner's E-mail Address
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City l�l.L' r..i i�c� i? iG`J'if•fi_.. State Zip r�i U Tele hone
APPLICANT'S NAME Last
First.
Applicants Address
Applicant's E-mail Address
city State -
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Zip ���^, Telephone
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ARCHITECT/DESIGNER'S NAME Last F
First f ---f
Lic. No. F._--
Architect/Designer's Address
Architect/Designer's E-mail Address
City - _ State
Zip [_ - Telephoner"-- -
ENGINEER'S NAME Last >
First 5 Lic. No L, 7 j
Engineers Address
Engineer's E-mail Address
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Zip{ Telephone Ci
CONTRACTOR'SNAME/COMPANY
Lic. No. r--- Class
Contractor's Address
Contractor's E-mail Address
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Zip F_� Telephone l -.--_--_-
SETBACKS REAR SETBACKS FRONT
PERMIT NO. X &C)
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. ff
USE ZONE , ,,z _ DEVELOPMENT NO
PLAN CHECK FEES $
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