HomeMy WebLinkAboutpv2021-235 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application
F- Comm'] r- Residential City of Newport Beach -Building Division Q �
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMI AL
F—Building r.— Grading Drainage rElec r-Mech F_ Plum Cu Yd C�tF Cu Yd Fill F
Project Address (Not mailing address) F Flood r Fire 1- Liq I— Landslide rN/A Floor Suite No
4 J/ 1
Description of Work I� Ii f Use Const Type
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r,, / y / f # Stories #Units (if Res)
aluation S
New/Add SF— Remodel SF� Garage/New/Add s— Material/Labor
OWNER'S NAME Last M
c1 r2n First
Owner's Address Owner's E-mail Address
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City I V a I- SUIJ, State % i Zip Telephone—
APPLICANT'S NAME Last �` Firsts
Applicant's Address Applicant's E-mail Address
City I�nlRState FC..
Telephone51-Ztqgq 3yI
ARCHITECT/DESIGNER'S NAME Last �— First Lic. No. F—
Architect/Designer's Address Architect/Designers E-mail Address
City State �— Zip F Telephoner
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ENGINEER'S NAME Last i' y f �;� ; �j ! First t.,/ Lic. No.
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En ineer's Address AAF /Jw 1.
Engineer's Engineer's E-mail dress'
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City State F Zip Telephoner
CONTRACTOR'S NAME/COMPANYS._�
L Lic. No. I0� pgz q Class u lrv,�z _ "
Contractor's Address
Contractor's E-mail Address" � 4-4 - ,
City no (anc State( A Zip � r� I Telephone 915 � �� �i°I Z� �.
SETBACKS REAR SETBACKS FRONT`t��
PER' IT NO.
SETBACKS LEFT SETBACKS RIGHT P N CHECK NO.
USE ZONE DEVELOPMENT NO IZ PLAN CHECK FEES $