HomeMy WebLinkAboutPV2021-197 - Permit ApplicationPrint Form _ Worksheet for GOmbo Building & Solar Permit -� � r � Application
r Comm'I F7 Residential P
City of Newport Beach - Building Division t Vr T � � - � �NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL F
[X Building r Grading fXDrainage (X Elec FX_ Mech FK- Plum Cu Yd Cutr Cu Yd Fill
Project Address (Not mailing address) rX_' Flood
r Fire F Liq r Landslide [X_N/A Floor Suite No
Description of Work
Use F Const Type
# Stories # Units (if Res)
New/Add SFF— Remodel SFr—.--
Garage/New/Add F_
Valuation$f�,f"
Material/Labor ,{ / :- 11,11i
OWNER'S NAME Last --� ,fir
t`;
First F-,
J✓ . C
Owner's Address
Owner's E-mail Address
3C 7v
Cit ' + r A' -
y I C11, L -i State Zip ri ; (' Telephoner
.. _
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L'
APPLICANT'S NAME Last c;trt^c'i /,'`..
FirstF !
Applicant's Address
Applicant's E-mail Address
City State
Zip r Telephone ` 11 n__ i; Z 7 C"C
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designees Address
Architect/Designer's E-mail Address
City State �—
Zip r Telephone
ENGINEER'S NAME Last
First F Lic. No.r —
Engineer's Address
Engineer's E-mail Address
City State
Zip Telephoned
CONTRACTOR'S NAME/COMPANY
Lic. No. Fu ( 5 1 S Class
Contractor's Address
Contractor's E-mail Address
City State F
Zip [ Telephone
SETBACKS REAR SETBACKS FRONT
PERMIT NO. R 'v 2f
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $