HomeMy WebLinkAboutM2021-0053 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
F Comrn'l F! sidential M2)7,il OU $3 City of Newport Beach -Building Division 30(09 rA 61v S
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
f—Building
F -Grading F -,Drainage f,—..Elec Mech F -Plum cu Yd cut Cu Yd Fill
F
Address
39or? � 3101
Description of Work
it mailing address) [_ Flood r—, Fire F_ Liq F_ Landslide __N/A
M*,c�
New/Add SF F_ Remodel SFF—. Garage/New/Add
OWNER'SNAME Last
Owner's Address
City State E
First
Owner's E-mail Address
Zip
Floor Suite No
F_
Use F7Const Type r
9 StoriesF—# Units (if Res)F
Valuation $
Material/Labor
I APPLICANT'S NAME Last i A(`Catz,s I First j M, k& I
Applicants Address
I- . ... ..... .....
city I State
Applicant's E-mail Address
Zip Teleph o ne
ARCHITECT/DESIGNER'S NAME Last Ll,. No. F_
Architect/Designer's Address
I------ - __ - - -----------
City
----------
city : State F77
ArchitecVDesignees E-mail Address
---- -----------
Zip F_ -
Telephone
ENGINEER'S NAME Last I First F Lic. No. F77777
Engineer's Address
__ ......... .. ..............
City I_ State F -
Engineer'
s E-mail Address
Zip Telephoner -
CONTRACTOR'S NAME/COMPANY Lko J, Lic. No. Class
Contractors Address
City State F Or
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
Contractor's E-mail Address
I.-_ - -_ , - - --- - ---------- --
ZIP [ �2( 12- _ Telephone[ 7U1- 741 -968R
PERMIT NO.
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $