HomeMy WebLinkAboutX2021-2413 - Permit Application (2)�; Princ Form ='� Worksheet for Combo Building & Solar Permit Application@ma
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F- Comm'I r Residential City of Newport Beach - Building Division X2®21— 2t{
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
ilding F_Grading [—Drainage rElec r'Mech ('Plum ca Yd cut Cu Yd Fill
Project Address (Not mailing address) F Flood F— Fire Liq F_ Landslide F_N/A Floor Suite No
Description of Work
Use Const Type �I
# Stories # Units (if Res)s
Valuation $
Material/Labor , \l
New/Add SF�— Remodel SF F_ Garage/New/Add
OWNER'S NAME Last � � Ast
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Owner's Address Owner's E-mail Address
City �JE.� P ` State�� Zip Telephone — `(�30)s
APPLICANT'S NAME Last First �> G
Applicant's Address 1� Applicant's E-mailAddress
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City zWe(z g mow\ State � Zip r , � Telephoned
ARCHITECT/DESIGNER'S NAME Last` First (y' ��'
E_Lic. No.
Archaitect/Designer's Address Architect/Designer's E-mail Address
City C� State F Zip g� / Telephone
ENGINEER'S NAME Last First Lic. No.
Engineer's Address Engineer's E-mail Address
City State sp Zip � Telephoned
CONTRACTOR'SNAME/COMPANY lC.b, Lic. No. V" c`i SG�J Cc),eS; C �� 3 .
Contractor's Address Contractor's E-mail Address
CityW�\\ State �— Zip Telephone O.
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SETBACKS REAR SETBACKS FRONT !21� RMT NO. ✓
SETBACKS LEFT SETBACKS RIGHT (� (�� PLAN CHECK NO.
USE ZONE DEVELOPMENT NO �� PLAN CHECK FEES $
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