HomeMy WebLinkAboutPV2021-258 - Permit ApplicationPrint Form_ j Worksheet for Combo Building & Solar Perm! A lication o�eW�Ra
FX Comm'I X Residential City of Newport Beach -Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL G
FX -Building F7 Grading
FX -Drainage [XElec >;Mech rxPlum Cu YdCut F_ CuvdFill F_
Project Address (Not mailing address) FXT Flood r" Fire FX_ Liq r Landslide rN/A Floor Suite No
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Description of Work
Use Const Type
# Stories #Units (if Res)
Valuation $
Material/Labor
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New/Add SFI---
Remodel SF--- Garage/New/Add F_
OWNER'S NAME
Last r A th First (YIV\
Owner's Address
`1 Owner's E-mail Address
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City
State F Zip F—TTelephone gqq S"67 31f )
APPLICANT'S NAME
Last a First 11A
Applicant's Address
Applicant's E-mailAddress
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City H -FD`
State ZiP ��0 Telephone(5� 51 5 p
ARCHITECT/DESIGNER'S NAME Last First 7-7--
Lic. No. F--
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State F-- Zip [_ Telephoned-_
ENGINEER'SNAME
�JGv1� First Lic. No.
Last C1Cn��
Engineer's Address
Engineer's E-mail Address
Dom% A i S C 01�
City 67 ^
State Zip qO Zi Telephone --
CONTRACTOR'S NAME/COMPANY Lic. No. apl ) Class t, q
Contractor's Address
Contractor's E-mail Address
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City F _
State �- - Zip F_Telephone k 1jW7 ,q (7
SETBACKS REAR
SETBACKS FRONT PERMIT NO. N V_rV )
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. ZC1
USE ZONE
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