HomeMy WebLinkAboutPV2021-255 - Permit ApplicationPrint Form;, Worksheet for Combo Building & Solar Permit Application on
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F_ Comm'l F_ Residential City of Newport Beach - Building Division
MV U21-255 C. P
NOTE: PLAN CHECK FEES DUE AT TIME OF SUB TTAL
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Project Address (Not mailing address) [7 Flood Fire f- Liq N/A Floor Suite No
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Description of Work
Use F7 Const Type
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Valuation $ 2 oI
MMaterial/LaboriLabor P
New/Add SFF777 Remodel SFF77777 Garage/New/AddF__
OWNER'S NAME Last First
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Owner's Address Owner's E-mail Address
City StateF zip r—TelephoneF
APPLICANT'S NAME Last First LEIM
Applicant's Address Applicant's E-mail Address
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city State Zip Telephone Ec
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ARCHITECT/DESIGNER'S NAME Last First F777777 Lic. No.F77777
Architect/Designees Address Architect/Designer's E-mail Address
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----- - -_ --- -_ - - -------------
City ... .. .. ... ... State zip F7777 TelephoneF
ENGINEER'S NAME Last - - --- - -- - ------ First F77777 Lic. No.F7777
Engineer's Address Engineer's E-mail Address
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City State ZIP Telephonel . .............
CONTRACTOR'S NAME/COMPANY lip ed 501 ej Vr Lic. No.;Class (LIZ
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Contractor's Address Contractor's E-mail Address
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City State F Zip Telephoneff—Z 7. si
SETBACKS REAR SETBACKS FRONT PERMIT NO. PV:IZ I Z, 6!�
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.ZC7