HomeMy WebLinkAboutPV2021-116 - Permit Application?VMV . ou
Print Form Worksheet for Combo Building & Solar Permit Application �1E Mr
City of Newport Beach - Building Division fl
F_ Comm'I r Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
T,Building [ Grading rDrainage rElec F__Mech r Plum CuvdCut F CuvdFill
Project Address (Not mailing address) I- Flood r` Fire r Liq F- Landslide r -N/A Floor Suite No
Description of Work
Use F_ Const Type F_
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# Stories #Units (if Res)
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Valuation
Material/Labor
New/Add SF�-- Remodel SFF------- Garage/New/Add I--"'
OWNER'S NAME Last F—� Firsf
Owner's Address Owner's E-mail Address
City �- .._ State .. Zip I TelePhoneF__
APPLICANT'S NAME Last A " "j ii First F
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Applicant's Address Applicant's E-mail Address
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e v,v1 State C. Zi t' Tele hone
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ARCHITECT/DESIGNER'S NAME Last I First F_ Lic. No.
Architect/Designer's Address Architect/Designer's. E-mail Address
City State �� ZiP F TelephoneF�
ENGINEER'S NAME Last First F — Lic. No.1
Engineer's Address Engineer's E-mail Address fir}
City �� _... :.... State r_._—.. ZipITelephoner
CONTRACTOR'S NAME/COMPANY 11 r ` Lic No. q 62 STS Class FC tt�
Contractor's Address Contractor's E-mail Address
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City
StateVAZiPll£��... TelephoneFTe 63,icf/59q—gL"ir' o
SETBACKS REAR SETBACKS FRONT PERMIT NO.
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SETBACKS LEFT SETBACKS RIGHT 6 1 4—)—� PLAN CHECK NO. Id
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $ _ J ,, 1Jy
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