HomeMy WebLinkAboutX2021-2577 - Permit ApplicationPrint Form j Worksheet for Combo Building & Solar Permit Application o��EWP°RB
F Comm'I jr�esidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL X aOPP d 5 %Z Fp 0.HP
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F—Building r Grading FDrainage F_ Elec F_ Mech F— Plum Cu Yd Cutl Cu Yd Fill F
Project Address Not mailing address) [_ Flood F Fire j— Liq F Landslide FN/A Floor Suite No
Description of Work
Use Const Type
Stori # R
# es Units (if es)[
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Valuation $ i a
Material/Labors
New/Add SF� Remodel SFj,Garage/New/Add �
OWNER'S NAME � Q�,�,
Last First
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Owner's Address Owner's E-mail Address
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CityF) L.--J�-.. _ State p Telephone
Zip p 31t� �f�b
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APPLICANT'S NAME Last ..�vv✓� V \-.. First
Applicant's Address Applicant's E-mail Address
City dn State Zip l �; TelephoneF� i7 r_�2 t, G ' �OS
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
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F_ F
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City State F - Zip Telephone_
ENGINEER'S NAME Last FirstF77777. Lic. No.
Engineer's Address Engineer's E-mail Address
_._ _ _-- _._.. ---
City State �� Zip Telephone
CONTRACTOR'S NAME/COMPANY Lic. No. F Class
Contractor's Address Contractor's E-mail Address
City State F Zip Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO. YI
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $