HomeMy WebLinkAboutX2021-1916 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
Comm'I Residential City of Newport Beach - Building Division d
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F-Building F_ Grading
rDrainage F_ Elec Mech r Plum Cu yd cutr Cu Yd Fill F
Projectfit Address (Not mailing address) F- Flood r Fire F_ Liq r Landslide r_N/A Floor Suite No
r
Description f Work _
Use F—ConstType F_
# Stories #Units (if Res)
Pw (}
Valuation /e"� C ^y
bor / ••�°
Material/Labor
New/Add SFF—
Remodel SF� Garage/New/Add 7
OWNER'S NAME
Last t- ' '- + FirstC
Owner's Address
Owner's E-mail Address
City
State-.t_ Zip �Telephon
(Tt
APPLICANT'S NAME
Last.. �_:;ys;<p.,, First I Mae'
Applicant's Address
Applicant's E-mail Address
City F' .4"�`
State I '+ — Zip ks Telephone g .��
Fi
ARCHITECT/DESIGNER'S NAME Last '; Gk,, First Lic. No.
Architect/Designer's Address
Architect/Designees E-mail Address
City
State I- Zip 7 Telephoned 1�
U
ENGINEER'S NAME
Last First F Lic. No.
Engineer's Address
Engineer's E-mail Address .
City
State F Zip F Telephoner
CONTRACTOR'S NAME/COMPANY y -r-4 � ' Lic. No. g lass
Contractor's Address
Contracto 's E-mail Address
��'LT�elephone
City -
State Zip
SETBACKS FRONT PERMIT NO.
SETBACKS REAR
c�V�
SETBACKS LEFT
/ /—
SETBACKS RIGHT PLAN CHECK NO. �'/,j'
_
USE ZONE
ii
DEVELOPMENT NO �-� ��C' L l C y> 0, PLAN CHECK FEES $