HomeMy WebLinkAboutX2021-0070 - Permit Application (3)�W.orksheetfcir Combo Building& Solar PermitApplication-
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F-1 Comm'l' F_; Residential City of Newport Beach - Building Division X UZI
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
r–IBuilding El Grading Drainage F-
Elec ['I Mech f7 Plum Cu Yd Cut Cu Yd Fill
C t m; –1 Fire r– Liq Landslide
Project A t mailing address) F] Flood r
jN/A Floor Suite No
Description of Work
2n) Use Const Type
0 # StoriesF_ # Units (if Res)r__
Valuation $
New/Add SFF__ Remodel SF Garage/New/Add 1777 Material/Labor
OWNER'S NAME Last First
Owners Address Owner's E-mail Address
city
State Zip [7777777 Telephon7rA
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
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city ---- - ------- State C-.6 Zip Telephonet �)l t4l*– 2�4 I
ARCHITECT/DESIGNER'S NAME Last First Lic. No. F-77 7
Architect/Designer's Address
City State F_
Architect/Designers E-mail Address
Zip TelephoneL--------,,----
ENGINEER'S NAME Last o LCy First
Engineer's Address
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City
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city uv> State
Lic. No.F_E_iTS___3
Engineer's E-mail Address
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Zip Telephon --7. k
CONTRACTOR'S NAME/COMPANY S–,
P Lic. No.✓ Class F9
Contractor's Address,
City
State F
(SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
f USE ZONE DEVELOPMENT NO
Contractor's E-mail Address
telephon : 771
PERMIT NO.
PLAN CHECK NO.