HomeMy WebLinkAboutX2021-3240 - Permit Application (2)I>'Pnrit Worksheet for Combo Building & Solar Permit Application
F_ Comm'I F-, Residential _ I City of Newport Beach - Building Division X 7/v2,1 . 3Zq
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
r -,Building [Grading F -Drainage, F-Elec F`Miech
F—Plum Cu Yd (:Vt
F
Cu Yd Fill
F_
Project Address (Not mailing address) F_ Flood
F- Fire F_ Landslide
Liq F_
F_N/A Floor
Suite No
Z31 g- 6lx.
. . ....... ...... ------ ------
1
F
—�11uvb(
F7
New/Add SF I Remodel
OWNER'S NAME Last
Owner's Address
S' r,4jj1qf(jt pt
City State
Last
Applicants Address
City State
Garage/New/Add
First I A4417
Use F7 Const Type
# StoriesF__ # Units (if Res)F_
Valuation $
Material/Labor F
Owner's E-mail Address
- - ----- ---- - - - -- - ----------
ZipF-et-
4t,, -
First
Applicant's E-mail Address
Zip F TelephoneF777777
ARCHITECT/DESIGNER'S NAME Last First 177777 Lic. No.
Architect/Designer's Address
----- -----
city State
Architect/Designers E-mail Address
Z!pF—. Telephone
- ------ -- ---- -_-
ENGINEER'S NAME Last First Lic. No.
Engineer's Address
.. . ....... . ........ .
Pity[ State F
CONTRACTOR'S NAME/COMPANY
Engineers E-mail Address
Zip j Telephone
Lic. No. Class F_
Contractor's Address Contractor's E-mail Address �
0 I%IC,'j 190" CZV roZ' PA iiq f C_ DIW;JY w4jv(l
- - --
City
city F State [ -1 5 -2
TelephoneF( q�) _ ?�e _9,11
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
PERMIT NO. M JZA
PLAN CHECK NO.
PLANCHECK FEES