HomeMy WebLinkAboutX2021-2180 - Permit Application (2)Print Form A Worksheet for Combo Building & Solar Permit A plication
rX Comm'I FX_! Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUB I AL
FBuilding F>T Grading (XDrainage r,Elec rX'Mech rx=IPlum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) FX_ Flood rX Fire FX_ rX; Landslide (KN/A Floor Suite No
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Description of Work
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Valuation $
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NAME /
OWNER'S Last
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Owner's Address
Owner's E-mail Address
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APPLICANT'S NAME Last
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First �R N
Applicant's Address
Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME
Last S�P,�Vj
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First /Ii�I��I��� Lic.No.�--
Architect/ esigner's Address
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Architect/Designer's E-mail Address
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Zip Telephone) "�
ENGINEER'S NAME Last
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First 5;E COCO Lic. No.r`��c� (�
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Engineer's Address
Engineer's E-mail Address
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State r_
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Zip �L� _ Telephone �� f • 5 `� �I
CONTRACTOR'S NAME/COMPANY Lic.No. q 3 31 z, Class
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Contractor's Address
Contractor's`JE-mail Address
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SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
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PERMIT NO. lg0y,
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PLAN CHECK NO
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $