HomeMy WebLinkAboutX2021-3064 - Permit Application (2)I,_Pnnt Form`.; _j �( �W�orksheet for Combo Building & Solar Permit Application
F- Comm'I r ResidentiaTZt , 30(0 4 City of Newport Beach -Building Division `-t5- CAA
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL e, i
Grading [—Drainage ['Elec Mech F—Plum Cu
Cu Yd Fill
Address (Not mailing address) C Flood r Fire [ Liq r Landslide f -N/A
New/Add SF Remodel SF i 6 7 5 Garage/New/Add
OWNER'S NAME LastFirst I
Owner's Address
Owner's E-mail Address
V
City Q W — —13 P State Zip Telephoned
Floor Suite No
I -
Use Sf'� Const Type _ u/
# StoriesFT # Units (if Res)F,
Valuation $
Material/Labor)
APPLICANT'S NAME Last
Applicants Address nn ss
City\✓��J V C U Cotv)� c� — State _. C4
First, Jv (
Applicant's E-mail Address
Zip �i2 (�7 °t Telephone `T I Lf0----------
ARCHITECT/DESIGNER'S NAME Last First Lic. No. F—-
Architect/Designer's Address
City �— State �—
Architect/Designer's E-mail Address
Zip r Telephone
ENGINEER'S NAME Last First Lic. No f
Engineer's Address
City State �—
Engineer's E-mail Address
Zip F Telephone
—
CONTRACTOR'S NAME/COMPANY Lic. No.�U3 91 �'_ I Class
Contractor's Address
--.. --------------
city
City State F
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
Contractor's E-mail Address
Zip Telephone[ ---—
PERMIT NO.
PLAN CHECK NO. ZOO Z Z,
PLAN CHECK FEES $