HomeMy WebLinkAboutX2021-2588 - Permit ApplicationPjlnt Form Worksheet for Combo Building & Solar Permit pplication
F_ Comm'I Residential City of Newport Beach - Building Division MA 0
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTA ",
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F_Mach F-PlumCu Yd cut r Cu Yd Fill
Project Address (Not mailing address) F_ Flood F-, Fire r Liq [_— Landslide FN/A Floor Suite No
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SCG tClC F F_
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Description of Work
Use F Const Type
# StoriesF;?- Units (if Res)
Valuation$
Material/Labor /V � v
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New/Add SFF Remodel SF� Garage/New/Add
OWNER'S NAME Lastvg61S First �v sok
Owner's Address Owner's E-mail Address
City � &A(, State Zip F TelephoneF777777
APPLICANT'S NAME Last a yj_ First
Applicant's Address Applicant's E-mail Address
City lZeq C /n State /O Zip F7Z— Telephone (!
ARCHITECT/DESIGNER'S NAME Last First F Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City StateF — Zip Telephone�—
ENGINEER'S NAME Last� f ►1 L j/I 0 First �lnn A/1— Lit. No. 0 I n
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Engineer's Address Engineer's E-mail Address
City State F Zip �— Telephoned
CONTRACTOR'S NAME/COMPANY 9f0fi��e&/ ` Lic. No. /�f/� Class
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Contractor's Address Contractor's E-mailAddress
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City �y�,�II (0�l�
�tC State zip
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SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. 1 j
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $