HomeMy WebLinkAboutX2021-2511 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application o�EW�RO
F" Comm'[ (- Residential City of Newport Beach - Building Division fin\ C
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Auilding j- Grading rDrainage F_Elec F_Mech F-PlumCu Yd Cut Cu Yd Fill F
Project Address (Not mailing
address) F_ Flood r- Fire F- Liq F_ Landslide FN/A Floor Suite No
fr6 C,� r r, F
Description of Work
e .
Use Itj , Const Type
# Stories? # Units (if Res)r—
! _
a
New/Add SF�— Remodel
S: Garage/New/Add F
Valuation $
Material/Labor F-)_nl�
OWNER'S NAME Last
11 JI�_ First
Owner's Address
Owner's E-mail Address
City J\�Z- 1n_ "rc>�t: "`,�G c `rj.
State i Zip`.� c �.�i. Telephone rl 1 � Yr2� I � l
APPLICANT'S NAME Last
,w t°-' 1 First j
Applicant's Address
Applicant's E-mail Address
Cit
State Zip I " I 7 J Telephone 11
ARCHITECT/DESIGNER'S NAME
Last First Lic. No. F_
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State F_ Zip F— Telephoned
ENGINEER'S NAME Last
First .)v` r-1 Lic No. - x,;,
Engineer's Address
Engineer's E-mail Address
F
City Vim(; F.p J^,
State Zip '� C 7 j� Telephone �; J
CONTRACTOR'S NAME/COMPANY
L 1� e Lic. No. k Class
Contractor's Address
Contractor's E-mail Address
City �;✓
State LE, Zip— Telephoned j �Lu_
SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACK
SETBACKS RIGHT PLAN CHECK NO.
USE ZO E
DEVELOPMENT NO t/� V� �� PLAN CHECK FEES $ 1 0