HomeMy WebLinkAboutX2021-2882 - Permit Application (2)Print Form,i I Worksheet for Combo Building & Solar Permit Application (4,
F- Comm'I (Residential City of Newport Beach - Building Division �20U-23162NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMI AL Fo„.
rlBuilding [ Grading r6>.,{rainage D�,Elec FMeth wq- Cu Yd cut F_Cu Yd Fill F_
Project Address (Not mailing address) F Flood r Fire F, Liq F! Landslide FN/A Floor Suite No
G KGs' _U M
Description of Work
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+6� I. �'�1�'
Use F_ Const Type
3k%X4 W ✓R6,j J,
660 �1%AJiacS L���'G�jG/G
# Stories, # Units (if Res)
Le
New/Add SF � Remodel SF�—
Garage/New/Add F
Valuation $
Material/Labor
OWNER'S NAME Last
5..�
First
Owner's Address
Owner's E-mail Address
City
State I Zip Telephone
APPLICANT'S NAME Last
First M1i2-
Applicant's Address
Applicant's E-mail Address
City
State
Zip �— Telephoner
ARCHITECT/DESIGNER'S NAME
Last
"e_ j First ---
/7FJd J jCj/i Lic. No.
Architect/Designees Address
Architect/Designer's E-mail Address
City SA DA A NQ
State o
Zip (r�� , 5 Telephone;,,/ Z- -53w • i0��-j 6
ENGINEER'S NAME Last
First Lic. No. F_
Engineer's Address
Engineer's E-mail Address
City
State
Zip �— Telephone—
CONTRACTOR'S NAME/COMPANY
-4 �
Lic. No. Class
Contractor's Address
Contractor's E-mail Address
City
State �—
I
Zip �— Telephoned
SETBACKS REAR
SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO. U1j
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $