HomeMy WebLinkAboutX2021-2875 - Permit ApplicationPrint Form J Worksheet for Combo Building & Solar Per t Application
F_ Comm'I f' Residential City of Newport Beach - Building Division Ii2$�
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding F_Grading 'Drainage [Elec F_Mech FPlum CuvdCut F_ Cu Yd Fins
Project Address (Not mailing address) C Flood r Fire F7 Liq f- Landslide F_N/A Floor Suite No
_ 1$Z-5 W 9.ul6a - F_-
Description of Work Use F_ Const Type
Re✓Ll-tG�S: add efer�trlr 3 Replace
# Stories # Units (if Res)s
N%Utl.ot $to(�N
Valuation
New/Add SFF—', Remodel SF F77777 Garage/New/Add F7-- Material/Labor
WWVV
OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
City State � Zip F Telephoned
APPLICANT'S NAME Last
Applicant's Address
City State
First
Applicant's E-mail Address
Zip F_ Telephones
ARCHITECT/DESIGNER'S NAME Last First 1, - Lic. No.
Architect/Designer's Address
City State F
Architect/Designer's E-mail Address
Zip �— Telephoned
ENGINEER'S NAME Last First Lic. No.
Engineer's Address
City State
Engineer's E-mail Address
Zip F Telephone
CONTRACTOR'S NAME/COMPANY Lic. No. F— Class F_
-
Contractor's Address Contractor's E-mail Address
City State Zip Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO. 7 5
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. R6U276-(IfK6
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $