HomeMy WebLinkAboutX2021-1530 - Permit Application (3)Form Worksheet for Combo Building & Solar Permit Application a `�`c"'a
jmm'I ( Residential City of Newport Beach - Building Division
NOTE. PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rrBuilding 0 Grading (iDrainage (f Elec Mech (d Plum cuYdCut CuvdFill
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Project Address (Not mailing address) F_ Flood j` Fire F_ Liq r— Landslide -_N/A Floor Suite No
202 87- 1VtFe5,o_P Dr-,r F- F_
Description of Work
Use ConstTypqup
Demo
# Stories #Units (if Res)
Valuationa 1500
Material/Labor �
New/Add SF Remodel SF Garage/New/Add
OWNER'S NAME LastIPRIANfjj R 1
Owner's Address - Owner's E-mail Address
City State F Zip o Telephon
APPLICANT'S NAME Last �— First
Applicant's Address Applicant's E-mail Address
City State �— Zip � Telephoned
ARCHITECT/DESIGNER'S NAME Las j t f"`1 b/,t� First Lic. No. F—
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Architect/Designer'sr'''s Address ArchitecUDesiig�,n�e/r'ssEEmma'il Address
t
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City My State Zip O� I �� Telephone iv •
ENGINEER'S NAME Last First Y tAM l Lic. No
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Engineers Address I Engineer's E-mail Address
City F_ State F— Zip Telephone[ —
CONTRACTORS NAME/COMPANY Lic No. Class F_
Contractor's Address Contractor's E-mail Address
City F_ State Zip � TelephoneF—
SETBACKS REAR SETBACKS FRONT PERMIT NO. I r
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. e
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $ ._