HomeMy WebLinkAboutPV2021-236 - Permit ApplicationPrint Form'; j Worksheet for Combo Building & Solar Permit Application
f- Comm'I J_ Residential City of Newport Beach - Building Division \pV '2,o2,j • 22_-.�
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
ABuilding Grading Drainage [Elec F_Mech F--PlumCuvdCut cuvdFill
Project Address (Not m� a\iliing address)( F_ Flood F_ Fire r Liq F- Landslide �N/A Floor Suite No
r I/. YY IC�VI
New/Add SFF7777 Remodel SF� Garage/New/Add
OWNER'S NAME Last
Owner's Address
APPLICANT'S NAME Last
First
Use F7 Const Type F
# StoriesrF # Units (if Res),
(Valuation$ `
F777- Material/Labor 6/
Owner's E-mail Address
_ _..
Zip[ 'i(' TelephoneF I�f
First
Applicant's Address Applicant's E-mail Address
__.......
City -x11= State Zip - L.-.. Telephoi
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designer's Address
City State �—
Architect/Designer's E-mail Address
Zip F__ Telephone�—
ENGINEER'S NAME Last ZGG1�First7�/ t Lic.No.1,�Y7
Engineer's Address
-. - -_
City State
Engineer's E-mail Address
Zip F Telephoned
CONTRACTOR'S NAME/COMPANY I `Uy\\ �n rm (�� I ('rt Lic.No. 41 Class"B
Contractor's Address
City T N� State r
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
Contractor's E-mail Address
Zip rye Telephone it �- s� -/ 17 )
PERMIT
"Elul •LX.7:1
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $