HomeMy WebLinkAboutX2021-3069 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
r Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F-Building F -Grading F -Drainage F-Elec F-Mech F-PlumCu Yd CutF Cu Yd Fill
Project Address (Not mailing address) C Flood F- Fire r Liq F- Landslide J -N/A Floor Suite No
Description of Work
Use F Const Type r
# StoriesF # Units (if Res)F—
Valuation �,.....
Material/labor �l
New/Add SFF— Remodel SF Garage/New/Add
OWNER'SNAME Last�(� First
Owner's AddressOwners E-mail Address
"JJMR OR yt
City�Telephone.J� �)
)L
V Ew \Ate _Zip h
APPLICANTS NAME Last IT First
Applicant's Address Applicant's E-mail Address
city f✓�� 1"G. �i./, State .�v Zip _ I '70 c3 Telephone ) �
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
Clly F State F Zip F— TelephoneF_
ENGINEER'S NAME Last X i A 0 First 5 [A k)&- Lic. No. S ati
Engineer's Address Engineer's E-mail Address
X510 (S�kcbbk FID 4,I)vV
City _� et N \ (A A, {) State Zip, Telephone[7 / 4 66 '�. t),5_1 D
CONTRACTOR'S NAME/COMPANYNG.U.3 1 `� Lb,AJ,Si Lic.No.6�744dClassl'�
(A
Contractor's Address Contractor's E-mail Address
CityState Zip ) [jam Telephone)"] Q If
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. W "l
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $