HomeMy WebLinkAboutX2021-0310 - Permit ApplicationV,ql- v?C o
Print Form Worksheet for Combo Building & Solar Permit Application
F_ Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
wilding F_ Grading F Drainage F Elec f— Mech Plum Cu Yd cutF_ Cu Yd Fin F_
Project Address (Not mailing address) (_ Flood Fire F Liq F Landslide F_N/A Floor Suite No
F5� /
Description of Work
New/Add SF Remodel SF Garage/New/Add
OWNER'S NAME Last /V b(nU/ First /V C
Use Const Type V;—_k3
# Stories[ # Units (if Res)[
Valuation $
Material/Labor �f v
Owner's AddressOwner's E-mail Address
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City A.)y^ � State ? Zip Z Telephone
APPLICANT'S NAME Last 0 First���
Applicant's Address Applicant's E-mail Address
1�1-7�e /ZG?�� �i%� �� U Jc����re�'G� l�Gc�c rr.,�--fiy .
City ZWjvlt_� � �� State Zip �Z�v S" Telephone
ARCHITECT/DESIGNER'S NAME
Last I 1pi�"i -�S First �!?/? Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City F_YU`q V[il p, jf C State Zip �c�l Telephone — (j_� �c;� -
ENGINEER'S NAME Last First F Lic. No.
Engineer's Address Engineer's E-mail Address
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city y,G,� �t State Zip 2 Telephone
CONTRACTOR'S NAME/COMPANY =- il� u C A�— Lic. No. Class
Contractor's Address rr)� Contractor's E-mail Address
T LJ-6k t/N e- it .
City �? State C� Zip ��/_ Telephone
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT
USE ZONE
SETBACKS RIGHT
DEVELOPMENT NO
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEE