HomeMy WebLinkAboutX2021-2154 - Permit ApplicationPrint Formj Worksheet for Combo Building & Solar Permit Application o�EW�Ra
FX_ Comm'I FX_ Residential City of Newport Beach - Building Division t 07 i.
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building [X Grading
Drainage FX-Elec FXMech XX Plum Cu YdCut l Cu YdHIF
Project Address (Not mailing address) FX_ Flood rx_ Fire (X Liq r Landslide (X`N/A Floor Suite No
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Description of Work
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Use F_ Const Type
# Stories #Units (if Res)
New/Add SF
Remodel SF f __ Garage/New/Add I —
Valuation $
Material/Labor7C,;
OWNER'S NAME
Last First
Owner's Address
Owner's E-mail Address
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1 (--y £'\
City _
�•, � State G-- '�zip ��� Telephone
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APPLICANT'S NAME
Last ��' rr_ First
Applicant's Address
Applicant's E-mail Address
City ;I
State } : Zip Telephoner_ /
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ARCHITECT/DESIGNER'S NAME Last �-4...First c#� --
Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State Zip F Telephoned__._....--_
ENGINEER'S NAME
Last First Lic. No.F
-- _
Engineer's Address
� �--�� Engineer's E-mail Address
City
State �` Zip F_ Telephone y
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CONTRACTOR'S NAME/COMPANY
I a Lic. No.71 Cjj Class
Contractor's Address
Contractor's E-mail Address
City
State �(i Zip `1��� Telephone
SETBACKS REAR
SETBACKS FRONT PERMIT NO. X43
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. � �•'�U2�
USE ZONE
DEVELOPMENT NO T1009 t m PLAN CHECK FEES $