HomeMy WebLinkAboutX2021-2001 - Permit Application�- Print Form ',� Worksheet for Combo Building & Solar Permit Applicationft� ��'°Re
Comm'I Residential City of Newport Beach -Building Division X20 2Vv�
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL °
Building F_Grading Drainage [Elec F_Mech F -Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) F_ Flood 1- Fire F_ Liq r Landslide FN/A Floor Suite No
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Description of Work
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FC # Units ( ['
# Stories #Units if Res)
Valuation $
Material/Labor
New/Add SFF— Remodel SF7__ Garage/New/Add F_
OWNER'S NAME Last First I p 11
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Owner's Address Owner's E-mail Address
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City StateZip t `1 Telephone
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
City State F Zip F— Telephonel—
ARCHITECT/DESIGNER'S NAME LastFC `w FirstpQ(2_ `L Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
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City ILaLK State Zipl- _L/<,6 d Telephone 7Gft(C(�
ENGINEER'S NAME Last First Lic. No.F —
Engineer's Address Engineer's E-mail Address
City State F_ Zip F Telephoner
CONTRACTOR'S NAME/COMPANY C -DG (Jv�'(� l�� Lic. No.a2ltnl5j Class
Contractor's Address Contractor's E-mail Address
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City I Iry i ra. State I C' Zip L(9 04 Telephone ��` ,-j tl J Z'3g{ Q
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $