HomeMy WebLinkAboutPV2021-173 - Permit Application (2)Worksheet for Combo Building & Solar Permit Application
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WRIPID
F_ Comm'I F_ City of Newport Beach -Building ?4, Residential ng Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMI TA
02"
F -Building [Grading F_,Drainage F_ Elec Mech F_ Plum C, ydc,tF Cu Yd Fill F
Project Address (Not mailing address) F__ Flood F- Fire F-, Liq F- Landslide [_.N/A
Floor Suite No
Des I cription of Work Use Const Type
(A
. ..... . I-Bafl-em J_Suk___,.,a- liet-_ - -------- - - ------ - # StoriesFF # Units (if Res)
N�2 Valuation $
New/Add SFI.,------ Remodel SF F77777 Garage/New/Add F_ Valuation
OWNER'S NAME Last First[_ftj'�C
Owner's Address Owner's E-mail Address
City State
Fe—
eZip Telephonel LY -N F)IL5 - P
APPLICANT'S NAME Last
Applicant's Address 0,
City State
- ----- -- Fw-
First
Applicant's E-mail Address
Zip Telep ho ne
ARCHITECT/DESIGNER'S NAME Last I 777 — First Lic. No. F
Architect/Designer's Address Architect/Designers E-mail Address
City L State ZipTelephone
---- - --------- -----
ENGINEER'S NAME Last First Lic. No.
F561 -
Engineer's Address
CityState
stn_ LUQ_ _jD C,
F6 - -
Engineers E-mail Address
ZIP TeleplhoneFq� �-3 zz 4-7,S
CONTRACTOR'S NAME/COMPANY Lic. No.
Contractor's Address
0
City 1 "JXV1rte. State
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
Contractors E-mail Address
Zip PZw 4-_- Telephonel9t MS8 4 r7 i
PERMIT NO.
PLAN CHECK NO. ,)J(;) i flmt
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $