HomeMy WebLinkAboutPV2021-119 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
Comm'I r Residential City of Newport Beach -Building DivisionZp2' I 1
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMI TAL
F -Building F_ Grading Drainage [_Elec Mech Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) F_ Flood r Fire r- Liq r Landslide FN/A Floor Suite No
]Lr-V r\z v -
Description of Work
Use ConstTypeF-7
#Stories #Units (if Res)
Valuation $
Material/Labor
New/Add SFF — Remodel SFF- Garage/New/Add F—
OWNER'S NAME Last"% f( First
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Owner's Address UU77((
Owner's E-mail Address
( 7S3 B---UI�4E P �
City State F Zip F Telephoner
APPLICANT'S NAME Last First CC
Applicant's Address Applicant's E-mail Address
City State Zip I Telephone—
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State F Zip F—Telephonel—
ENGINEER'S NAME Last First Lic. Nof—'
Engineer's Address Engineer's E-mail Address
City State F Zip Telephone
CONTRACTOR'S NAME/COMPANY Lic. No. Class GC(
Contractor's Address Contractor's E-mail Address
City \J\ V i. State Zip Z ((:? Telephone q 75c? , o
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $