HomeMy WebLinkAboutX2021-0150 - Permit ApplicationL Print Form Worksheet for Combo Building &Solar Permit Application
Comm'I (- Residential City of Newport Beach - Building Division
` NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL VDl " oI 9U �OPNP
(C Building Grading
rDrainage F_ Elec F Mech F Plum Cu Yd Cut Cu Yd Fill F
Project Address (Not mailing address) f Flood r" Fire Liq j— Landslide FN/A Floor Suite No
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Description of Work
Use ConstType I""..-
# Stories[ # Units (if Res)[
New/Add SF
Remodel SF Garage/New/Add
Valuation $
Material/Labor
OWNER'S NAME
Last ��jd i �.L (, First
Owner's Address
Owner's E-mail Address
City f lt-j ie V
1 State C Zip I 6A—�' Lq (p `�j Telephone)
APPLICANT'S NAME
Last &Q,V.j First
�ars�
Applicant's E-mail Address
✓) ot-\Z) QQ,-:3 Wt=c�,t�=�,u SIv�C�@ C�Y
City tom(\
C. vvo
State Telephone e7\ G S L� % CJD C)
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designer's Address
Arch itect/Designer's E-mail Address
City I .
State Zip Telephone
ENGINEER'S NAME
Last First � Lic. No.F—
Engineer's Address
Engineer's E-mail Address
City �
State F_ Zip I Telephone��
CONTRACTOR'S NAME/COMPANY Lic. No. Class
Contractor's Address _
Contractor's E-mail Address
City
—
State F_ Zip I- Telephone
SETBACKS REAR
SETBACKS FRONT PERMIT NO.�
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $