HomeMy WebLinkAboutX2021-2902 - Permit ApplicationPrint Form J Worksheet for Combo Builaing & Solar Permit Application
City of Newport Beach - Building Division
( Comm'I Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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F-Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) i— Flood r Fire F.'Liq r LandslFde F_N/A Floor Suite No
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Description of Work p 0
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Use � Const Type
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it Stories # Units (if Res)F—
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Valuation$
Material/Labor u tV YV
New/Add SF Remode Garage/New/Add
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OWNER'S NAME Last yntno rt-�(�
First
Owner's Address
Owner's E-mail ��AYj
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City CoV'pe%CNIOLr State �—
Zip a{p;.5_ Telephoned
APPLICANT'S NAME Last D ✓!'S
First I TaA
Applicant's Address
Applicant's E-mail Address
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City �yOIA ti.� State
Zip govogw Telephone kj_ �1pa
ARCHITECT/DESIGNER'S NAME Last �a l s First Sr� Lic. No.
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Architect/Designer's Address
Architect/Designees E-mail Address
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City /,6�y �eG State VA.
Zip Telephone Z.:7/ _!s35
ENGINEER'S NAME Last
Firsti Emily Lic No.�
Engineer's Address
Engineer's E-mail Address
City F�J&°�JVO/+_ /���ph State Of4-
Zip OIa&/_ D Telephone—
CONTRACTOR'S NAME/COMPANY i 1w 1_ (�N r� cc t}5-�-coc (ic/I-) Lic No. I SE 1{� ClassD�
Contractor's Address
Contractor's E-mail Address
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City State F—
Zip Telephone /
M21
SETBACKS REAR (6 { SETBACKS FRONT /y / PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
1 PLAN CHECK NO.
USE ZONE ( DEVELOPMENT NO
PLAN CHECK FEES $