HomeMy WebLinkAboutX2021-0607 - Permit ApplicationX2oZI-ovo�+
Print Form Worksheet for Combo Building & Solar Permit Application o��EWPORr
F_ Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL �9L/c00.N`P
(—Building F_ Grading
'"Drainage F_ Elec Mech F— Plum cuYdCut F cuYdFill F
Project Address (Not mailing address) Flood F Fire F_ Liq (— Landslide F_N/A Floor Suite No
F_
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Description of Work
Use FV--3 Const Type
APA
or J- L:e-,
✓
# Stories # Units (if Res)[ —
/
Valuation
New/Add SF
Remodel SF Garage/New/Add
$
Material/Labor
OWNER'S NAME
Last ,pit Firsti . . ...........
r 1
Owner's Address
Owner's E-mail Address
City F
State F Zip Telephone
APPLICANT'S NAME
Last � � First
Applicant's Address
Applicant's E-mail Address
City
Q 6 wyv'f/►'1cGV" �/1�v`t'��i � �' �u)
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State Zip G� G Telephone✓ n -U
ARCHITECT/DESIGNER'S NAME Last �First Lic. No.
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Architect/Designer's Address
Arch itect/Designer's E-mail Address
City
State Zip Telephone
ENGINEER'S NAME
Last y�' v►' " First Lic. No.1
Engineer's Address
Engineer's E-mail Address
City
State Zip Telephoned
CONTRACTOR'S NAME/COMPANY Lic. No. � ass ����'.
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� � V Y ` I � ������
Contractor's Address
Contractor's mail Address
City F—
State �— Zip �� Telephoned
SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $