HomeMy WebLinkAboutX2021-2156 - Permit ApplicationPrint Form_ Worksheet for Combo Building & Solar Permit Application o De
(K Comm'I (X Residential City of Newport Beach - Building Division
NOTE: PLAN C^CK FEES�ti4T TIME OF SUBMITTAL
[XBuilding Fx Grading rDrainage Elec (X M h
FX PI Cu Yd CutF_ Cu Yd Fill F_
Project Address (Not mailing address) FX Flood
Fx Fire FX Liq FX Landslide FX_N/A Floor Suite No
Description of Work
Use F Const Type
# Stories # Units (if Res)F
Valuation $
Material/Labor afJ
^
New/Add SF d�e%'7 Remodel SF F Garage/New/Add F
OWNER'S NAME LastrZ
First Ch G!
Owner's Address
Owner's E-mail Address
City I /ve��7o✓k State
Zip Telephone
APPLICANT'S NAME Last. �
First �G
Applicant's Address
Applicant's E-mail Address
ouc zti lam.-
City /'/(i✓li State v T
/
Zip -l�% Telephone
ARCHITECT/DESIGNER'S NAME Last First Lic. No. F
Architect/Designer's Address
ArchitecttDesigner's E-mail Address
City State F_
Zip [_ Telephoned--
ENGINEER'S NAME Last �dGSG
First 11q,C_ g ( Lic.No.�-
Engineer's Address
Engineer's E-mail Address
City i�tif State
Zip 70% Telephone ]/Li �12G G�yZ
CONTRACTOR'S NAME/COMPANY `7 / / /,/ P S Lic No. ��J7/��j Class Fs
Contractor's Address
Contractor's E-mail Address
L�
City // /�C �{v�e C( State
r/ O /
Zip ��� (� /. Telephon 7/111
y
SETBACKS REAR• SETBACKS FRONT
PER O.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $