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HomeMy WebLinkAboutX2021-2217 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application F Comm'I Residential City of Newport Beach - Building Divisi NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL (Building fri, Grading JFDrainage -F Elec Address (Not mailing /V_Ci of Work 11�,Mech plum Cu Yd cut����_ � Cu Yd Fill ii 27ts c'Y L J _V� off')d ri�Flood [ Fire J Liq ❑ Landslide [JN/A Floor Suite No - LInCnH L uslr`f- __5 rQ Use) ConstType� #Stories #Units (if Res)nJJJJJJ -------- -- ,v lei /Add SF � ? 1 Remodel SFj� I Valuation $ �t'.� Gara Ne /Add Material/Labor �5 0 OWNER'S NAME I / I [----- - Last - First t Owner's Address -- - - t Owner's E-mail Address City � Yy-- V k J State Zip _ Telepho e APPLICANT'S NAME Last r First Applicant's Address - Applicant's E-mail Address ��(( ijo "( City ---.-�111 --- U�----- &/_ U ✓/'T � tZf ;� State I / (�-i Zip �YJ �9 , Telephon `M ARCHITECT/ IGNE ' NAME � / `(� Last —I First Architect/Designer's Address -Uj_I 1, Architect/Designer's E-mail Address City - -- ✓",�-_, _ -- State Zip _ Telepho'4444 _d 7&Z&ZI� Lic. No. ENGINEER'S NAME Last 9 � _ _�, _ First ' - Lic. No. Engineer's Address � _ Engineer's E-mail Address City --..�Y!./,q. '-/J-/-e. _.- - - ---- - State r 7 I Zip ��J f_%''j Telephon `�`t'I-_ __Tf9 CONTRACTOR'S NAME/COMPANY �(/J /rticrntan %nsd EsE-mall Lic. No. �SgaCContractor's Addressess City �p��� State Zipone SETBACKS REAR SETBACKS FRONT PERMIT NO., SETBACKS LEFT SETBACKS RIGHT t _ PLAN CHECK NO. USEZONE -_DEVELOPMENTf — _ p � � LAN CHECK FEESt �