HomeMy WebLinkAboutX2021-1187 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
r Comm'I I— Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building F Grading [—Drainage rElec j�Mech F" Plum cuYdCut F CuYdFill
Project Address (Not mailing
address) F_ Flood [_ Fire F Liq Landslide I_N/A Floor Suite No
� �� C�, 0_�,
I F_
Description of Work
Use [_ Const Type IYY �--
# Stories #Units (if Res)
CW J1�"VL, S
New/Add SFF7 Remodel
SF 114 II �Garage/New/AddF
Valuation $
Material/Labor Ce ej%Q. 'gb
OWNER'S NAME LastFirst
Owner's Address
Owner's E-mail Address
City \;
State I 6� Zip Telephone)
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City F
State F_ Zip Telephoned
ARCHITECT/DESIGNER'S NAME
Last First Lic. No.
Arch itect/Designer's Address
Architect/Designer's E-mail Address
City
State F Zip r Telephone
ENGINEER'S NAME Last F_
First I Lic. No.1Y---
Engineer's Address
Engineer's E-mail Address
City
State F Zip Telephoned
CONTRACTOR'S NAME/COMPANY
/ ,� , S' S � � Lic. No.[�; S 95, Class
�(1 1v
Contractor's Address
Contractor's E-mail Address
23j Ovv, '3 VQv%A o--q ,tom tt" -IJ
b-$��1'lbll
State I "'i:-- Zip GI (pe'1 ( Telephone �LIP
SETBACKS REAR
SETBACKS FRONT PERMIT NO. Q� j U
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $