HomeMy WebLinkAboutX2021-1361 - Permit ApplicationPnpt Form= Worksheet for Combo Building & Solar Permit Application
✓Comm'I Residential City of Newport Beach -Building Division v2 -Q am
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Building Grading Drainage rElec FMech rPlum cuvdCut F
Project Address (Not mailing address) F_ Flood i— Fire � Liq - Landslide N/A Floor Suite No
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Description of Work' Use 1rti Const Type v
#Stonesi #Units (if Res)
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9Valuation $
New/Add SF�' Remodel SFF— Garage/New/Add �— Material/Labor
OWNER'S NAME Last j x First
Owner's Address Owner's E-mail Address
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TelePhone
City State a fZiP
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APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
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CitE.f` 7 State Zi Tele hone
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,ARCHITECT/DESIGNER'S NAME Last iy, first Lic. No.F
Architect/Designer's Address i Architect/Designer's E-mail Address
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1, city m l State sib Zi �'— Telephone 1 ,i ,,t ?`
ENGINEER'S NAME Last First Lic. Nof—
Engineer's Address Engineer's E-mail Address
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City State Zip I _ _— Telephoned
CONTRACTOR'S NAME/COMPANY 'TbIMI 1 It l A Lic No. IDRo111 Class
Contractor's Address Contractor's E-mail Address
City State— Zip 2�� Telephone GI1�®S.Ur3I
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SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
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