HomeMy WebLinkAboutX2021-3411 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division
r Comm'I Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
uilding I_ Grading j—Drainage
F_ ElecMech
Ium Cu Yd cut
Cu Yd Pill
FPrtniiect Address (Not mailing
address) Flood
r'_ Fire r- Liq F_ Landslide
F_N/A Floor Suite
Description of Work Use ConstType
# Stories' #Units (if Res)
��ZG CnJ�
Valuatio
Remodel SF Garage/New/Add Material abo
New/Add SFr
OWNER'S NAME Last % j` First
Owner's Address ./� / ( Owners E-mail Ad es
State Zip-elephone
City r
APPLICANT'S NAME Last First F — —
Applicant's E-mail Address
Applicant's Add
City
' State �� Zip I J TelephoneF�
ARCHITECT/DESIGNER'S NAME Last �— First Lic. No. F_
Architect/Designer's Address Architect/Designer's E-mail Address
City State �— ZIP �—
Telephone��
ENGINEER'S NAME Last F__'
First F� Lic No.F_
Engineer's E-mail Address
Engineer's
Zip Telephone[�
City
�T .. Llc. No. �� Class
CONTRACTOR'S NAME/COMPANY I / A t �t/� /� �L I G(%
Contractor's Address I t / 1 Contractors E-mail Address
State r�j-- ZiprCJ w' Telephoned L 7
City \/
PERMIT NO.
SETBACKS REAR SETBACKS FRONT V
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. Z� � � � Z - �
USE ZONE DEVELOPMENT NO p2f PLAN CHECK FEES $