HomeMy WebLinkAboutPV2021-216 - Permit ApplicationPrint Form .__ Worksheet for Combo Building & Solar PermApplication rEWPogr
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Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES
DUE AT TIME OF SUBMITTAL
F-Building F_ Grading F-Drainage (-Elec F_Mech Plum Cu vd Cut[_ Cu YdF l F_
Project Address (Plot mailing address) F_ Fire F_ Liq r Landslide F_N/A Floor Suite No
a-o? C-_ a0'Cs +,oy CD �.
Description of Work
Use Const Type
# StoriesF_ # Units (if Res)F—
Valuation $
Material/Labor
New/Add SF[— Remodel SF� Garage/New/Add �—
OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
City State F Zip I I— Telephone---
APPLICANT'S NAME Last �" "
�Cn,'CYv�f',w�' First r Q"J
Applicant's Address Applicant's E-mail Address
Co M•
City State zip[ Telephone �1LI C(" 7 l l3
ARCHITECT/DESIGNER'S NAME Last First—
. Lic. Na. �—
Architect/Designer's Address Architect/Designer's E-mail Address
City State F zip Telephoned--
ENGINEER'SNAME Last O";, ✓ %''— - First Lic No.F_
Engineer's Address Engineer's E-mail Address
City State F_ Zip �— Telephoner
CONTRACTOR'S NAME/COMPANY —1M r_ _emu �t`a�s Lic. No. �C�t�r7L1�CIass�
I l7� l
J ( 1
Contractor's Address Contractors E-mail Address
)�C1Lk-CoAra
City I L Noy 17�G� StateVZi Telephone i (,•7
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.�d
USE ZONE DEVELOPMENT NO _ PLAN CHECK FEES $