HomeMy WebLinkAboutX2021-0244 - Permit Application-' Prirl Form_ "Worksheet for Combo Building & Solar Permit Application
Comm'I F_ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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F,Building
Address (Not mailing ad Flec �Mech F-plumcuvda,t�
Grading (-,Drains e _
Cu Yd Fill
dress) r Flood (- Fire r Liq F_ Landslide r,N/A Floor
Suite No
840- IVewPo(-� C er,k r Dr _
Description of Work
Use Const Type
# Stories #Units (if Rel
New/Add SF � Remodel SF �— Garage/New/Add F Valuation S
- -
- - - -- Material/Labor
OWNER'S NAME Last
First
Owner's Address - - - - - --
City
State -
zip[,Telephone�—_-_
APPLICANT'S NAME Last
r
- First
Applicant's Address
- -
Applicant's E-mail Address
City
- - - -- -
State -
ZIP F— Telephone—
_ _
ARCHITECT/DESIGNER'S NAME
Last First—
Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City I -
State �-
Zip — TelephoneF —
ENGINEER'S NAME Last
First F� Lic. No. �—
Engineer's Address
Engineer's E-mail Address
City
-
State I - - - -
Zip F TelephoneF—
CONTRACTOR'S NAME/COMPANY
�([�U tD S I M IZ N �—
CONSr�UC-r1O0 Lic. No. FBII�j Class) �J
Contractor's Address
Connt^trranactor's E-mailai���
IAddress
/� /
City
1Z) V I N e -
State
FC Zip
(I 7��Iy Telephone
- -
G(L}Ll)ZrJC)
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SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE ��_ _ DEVELOPMENT NO
PERMIT NO. 2- 0 2 ( - Oo,) Ll 4
PLAN CHECK NO.
PLAN -CHECK FEES $_