HomeMy WebLinkAboutM2021-0080 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application Q-5,r Comrn 1 Residential City of Newport Beach - Building Division oNOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building F_ Grading (-Drainage rElec F_Mech
F- Plum CuydCut s CuvdFill
Project Address (Not mailing address) F- Flood
f` Fire F_ Liq F- Landslide FN/ArFloor Suite No
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Description of Work
Uses ConstType F_
# Stories #Units (if Res)f
Valuation $
New/Add SF F_Remodel SFF—Garage/New/Add 7
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Material/Laborer ✓����—
OWNER'S NAME Last
Firstl`I
Owner's Address
Owner's E-mail Address
4017'a ✓/i' LICO
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City r --
Zip�� Telephone (;; ^ O�J����
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APPLICANT'S NAME Last /j0/
First /Z-41*-)
Applicant's Address
Applicant's E-mail Address
City State ��- —
Zip qj� Telephone g411— �8� �9-
ARCHITECT/DESIGNER'S NAME Last � First Lic. No.
Architect/Designer's Address
ArchitecUDesigner's E-mail Address
City State F_
Zip F_ Telephone ��
ENGINEER'S NAME Last ��Tl-'� ✓
lone
First FFJOI Lic. No.��7
Engineer's Address
Engineer's E-mail Address
2-ftgi co-5 rrAt; �r
PPMP*- ,cm>✓1
City I/%}�{J1 I� {(al)�iV State - -
Zip z�Z(p-1_7 Telephone 71 1�^ 1 7542
CONTRACTOR'S NAME/COMPANY
Lic. No. v-)jg0 Class
Contractor's Address
Contractor's E-mail Address
City State F_
Zip F_ Telephoned
SETBACKS REAR SETBACKS FRONT
PERMIT NO. V (I_z Ji V. `— 04
SETBACKS LEFT SETBACKS RIGHT
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PLAN CHECK NO. CN
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $