HomeMy WebLinkAboutX2021-2133 - Permit ApplicationX2o2�.-217-,�`
Print Form Worksheet for Combo Building & Solar Permit Applkation D41
F Comm'I X.Residential City of Newport Beach - Building Division (NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
uilding Grading F-Drainage F_ Elec F_ Mech Plum cuYdCut F CuYdFill F
Project Address (Not mailing address) F_ Flood Fire Liq F Landslide N/A Floor Suite No
Description of Work
Use F Const Type
# Stories #Units (if Res)
Valuation
New/Add SF Remodel SF Garage/New/Add
$
Material/Labor ; 25
1
OWNER'S NAME Last SY,n 3
First
Owner's
Owner's E-mail Address
/Address �7
C�S.\-
City �ShZ State
Zip ��✓i Telephoned Z<_ q3._R� �• —
APPLICANT'S NAME Last �ww
First��
Applicant's Address-s+y
Applicant's E-mail Address
City f�, State G
Zip � Telephone
ARCHITECT/DESIGNER'S NAME Last
�•'�' �y.., First i-\-v Lic. No.
V
Architect/Designer's Address
Architect/Designer's E-mail Address
City State
Zip Telephone qqj
ENGINEER'S NAME Last
First Lic. No.
Engineer's Address
Engineer's E-mail Address
City State r
Zip Telephones
CONTRACTOR'SNAME/COMPANY iic.No. Class
Contractor's
Contractor's E-mail Address
+Address
City State
Zip �Z �/ Telephone C/ c f 7 29 C/ -an
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $