HomeMy WebLinkAboutX2021-2413 - Permit ApplicationFnnt Fdrm, Worksheet for Combo Building & Solar Permit Application
F Comm'I (— Residential City of Newport Beach - Building Division )(2021— 2LI (3
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
ilding j- Grading j Drainage r Elec Mech r
r Plum Cu Yd Cut F Cu Yd Pill
Project Address
of Work
r7 Flood F,_ Fire r Liq F_ Landslide FN/
New/Add SF � Remodel SF�— Garage/New/Add F—
OWNER'S NAME Last
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Owner's Address J
Owner's E-mail Address
City IkJE� Ql �� `State F— Zip
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
- cG'Nle_ 1A(
City ZW9�r State �-
1 Y _ _ ZIP �� Telephor
A Floor Suite No
F—
Use Const Type I
# StoriesF # Units (if Res)[—
Valuation $
es)[—
Valuation$
Material/Labor
ARCHITECT/DESIGNER'S NAME
Last r"' First
i'%.�� Lic No
Architect/Designer's Address I`a ) ko 14
c� Architect/Designer's E-mail Address
ISO__ 5 1-_4 43c biE %Q S3; i
City ��5-
�� State Zip / Telephone O I L� �37
ENGINEER'S NAME Last So l i
Address
City State
First Lic No. F —
Engineer's E-mail Address
- - -
Zip �— Telephoner
CONTRACTOR'S NAME/COMPANY C�
S0S ;Q'J'/jer Lic. No. �( Classl r�
Contractor's Address Contractor's E-mail Address
City ?a\ State �Sr
�� C zip Telephone
SETBACKS REAR
SETBACKS LEFT
U EZONE
SETBACKS FRONT
SETBACKS RIGHT
V AN
RMIT NO. i
PLAN CHECK NO.