HomeMy WebLinkAboutX2021-3246 - Permit Applicationxmli 32-1 l9
Prim For Worksheet for Combo Building & Solar Permit Application orW�Ra
F— Comm'I F_ Residential City of Newport Beach - Building Division �
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL c<„oar'
Vbuilding rGrading [7Drainage rElec F_Mech F-PlumCu Yd Cut Cu Yd Fill
Project Address (Not mailing address) F Flood r— Fire F- Liq r Landslide FN/A Floor Suite No
Bul _�i�CI�7QlJ %
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Description of Work
Use', Const Type
11A ee♦r (
it n_
2 r/
# StoriesFF # Units (if Res)F_
New/Add SFF Remodel SFF—
Garage/New/Add F—
Valuation $
Material/Labor C,1 00
OWNER'S NAME Last -
Firsti�
Owner's Address
Owner's E-mail Address
riot Sra �oua�-_-- -I
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City 000.00k 00, -.VA(--. _._ State I Zip -t Telephone. -o3
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City State F_
Zip F_ TelePhoneF_,
ARCHITECT/DESIGNER'S NAME Last
First F Lic. No.
Architect/Designees Address
Architect/Designer's E-mail Address
- ---- _. _. -._
City ,. _ State F—.
ZipF Telephone'
ENGINEER'S NAME
First F_ Lic. No.�
'�L"ast
t " ?o'
Engineer's Address �-
Engineer's E-mail Address
r�-e.��
�r /
r5�; 3-
City State
_
Zip [7 ---- Telephoner
CONTRACTOR'S NAME/COMPANY � � \ Lic. No. R8 Z23-� Class F-zi
t _ I
Contractor's Address
Contractor's E-mail Address
3 CbP���E fE
�°1�ti21� ®"TGPQa1tVc1CJC,Cal c
City --GOe,6PA- State'
Zip . G TelephoneIr
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO + �ECK FEES $