HomeMy WebLinkAboutPV2021-193 - Permit Application (2)fV 747A •1013
Print Fc_rrW_j Worksheet for Combo Building & Solar Permit Application o�EW�Rm
i- Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
j -"Building f- Grading F -Drainage r-Elec rMech (-Plum CuvdCut r-- Cu YdFill F_
Project Address (Not mailing address) C Flood r Fire (- Liq F- Landslide F_N/A Floor Suite No
Description of Work
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# Stories # Units (if Res)
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New/Add SFF e/N
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Remodel SF�— Valuation /Add �— Material/Laa
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OWNER'S NAME Last /
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Owner's Address
Owner's E-mail Address
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.ZIPt ;c, �7 Telephone1—
APPLICANT'S NAME
Last [6 e., _tett .. - First I G ,,.' l ! ,6'i4 ---i �•
Applicant's Address Applicant's E-mail Address
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State �>> Zip ' , �l>j_h.-... Telephone��
ARCHITECT/DESIGNER'S NAME Last
t }� ,First �–p 'C— Lic. No. F—
Architect/Designer's Address ArchitecUDesigners E-mail Address
City tett.. _ _.. _ State r— Zip Telephoned
ENGINEER'S NAME Last First r--
Lic No.F_"
Engineer's Address Engineer's E-mail Address
City _ t atetett.
_ State r-- Zip �— Telephoned-
CONTRACTOR'S NAME/COMPANY n -r
Lic No. +� ? Y J Class 1 i
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Contractor's Address Contractor's E-mail. Address
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City,(" tett tett tett. .. Zip �Telephoner—
SETBACKS REAR SETBACKS FRONT PERMIT NO. U " -fieri — 1,� S
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $