HomeMy WebLinkAboutX2021-2938 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
1EW PORT
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F Comm'I r Residential City of Newport Beach - Building Division ?
NOTF PI AN f'.H PCI( Groc ni IC nT rrn.v 1. <>
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FWuilding F- Grading (-`Drainage F- Elec F Mech Plum Cu Yd j� I`
r Cut Cu Yd Fill
Project Address (Not mailing address) F_ Flood F` Fire FL Liq j` Landslide F_N/A Floor Suite No
Description of Work
Use P-U3 ConstType
# Stories # Units (if Res)[—
Valuation $
Material/Labor 2�16�
New/Add SFF— Remodel SF��
Garage/New/Add r---
OWNER'S NAME Last �}�
First
Owner's Address
Owner's E-mail Address
city � State Fi Zip F_ Telephoned
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
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City State F—
Zip [_ Telephone F_
ARCHITECT/DESIGNER'S NAME Last �� Y
First F_ Lic. No. F_
Architect/Designer's Address
I
Architect/Designer's E-mail Address
City F— __._ State
Zip F_ Telephone��
ENGINEER'S NAME Last F�
First F_ Lic. No. F_
Engineer's Address
Engineer's E-mail Address
City [— State
Zip [_ Telephoned
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CONTRACTOR'S NAME/COMPANY I
I `
Lic�l J l _q � 2Class
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Contractor's Address
Contractor's E-mail Address
City � State �—
Zip — Telephone F,
REAR SETBACKS FRONT
PERMIT NO. j1z,I ' ( IDETB
PKS
KS LEFT SETBACKS RIGHT
PLAN CHECK NO. OZ1V ` .��
ONE DEVELOPMENT NO
PLAN CHECK FEES $