HomeMy WebLinkAboutPV2021-265 - Permit ApplicationPrint Form �p Worksheet for Combo Building & Solar Permit Application Qswiiv.[-Comm'I F- Re derttial2l - ZkiS City of Newport Beach - Building Division (33ft Avt, .t1TVIA
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL (A/iA„i
[—Building [- Grading [-Drainage [-I Elec [- Mech [- Plum Cu Yd Cut cu Yd Fill F
Project Address (Not mailing address) [- Flood [- Fire f— Liq [- Landslide [N/A Floor Suite No
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Description of Work 9
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Use Const Type F_
# Stories FT #Units (if Res)'
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Valuation $
Material/Labor FAOVC7
New/Add SFF— Remodel SFF_ Garage/New/Add F
OWNER'S NAME/
Last YPc%_er __ First
Owner's Address Owner's E-mail Address
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City N�1pfY®� �tu(�^ State Zip R -2 -CO- Telephone Got Cj7h�
APPLICANT'S NAME Last First �M(�
Applicant's E-mail Address
Applicant's Address/^&
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City�p �p State - Zi Telephone
ARCHITECT/DESIGNER'S NAME Last First F Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State F Zip —�, Telephone '
ENGINEER'S NAME Last ( First Lic. No. j
Engineer's Address Engineer's E-mail Address
City State Zip Telephoned
CONTRACTOR'S NAME/COMPANY p1A^ d C (C Lic. No. q 7$�5 Z Class /C al
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Contractor's Address Co/ntrractor's E-mail Address
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City ^OV � FC SQry S State Zip t� 7Q Telephone �� 7 ((574 05
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SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. OM r1oz-4
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $