HomeMy WebLinkAboutX2021-2194 - Permit ApplicationPrint Form_ j Worksheet for Combo Building & Solar Permit Application o�EW�Re
(X Comm (X Residential City of Newport Beach - Building Division o
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building rX Grading fXDrainage F Elec jX Mech Fx- Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) fX Flood Cx Fire Cx Liq FX_ Landslide FXN/A Floor Suite No
Description of Work
Use Const Type r
7
#Stories #Units (if Res)
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Valuation $
New/Add SFRemodel SF�� Garage/New/Add
Material/Labor
OWNER'S NAME Last
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Owner's Address Owner's E-mail Address
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City F r�X �2 �VT F�', 0-t. � l - State ( �� Zip & Zi s �- Telephone��
APPLICANT'S NAME Last' 61)z. 0Iv, First ,I( l l'u m
Applicant's Address Applicant's E-mail Address
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City State Zip �f� Telephone! �7 / 7 �a G Z Z
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ARCHITECT/DESIGNER'S NAME Last First 9 �� Lic. No. �—
Architect/Designer's Address Architect/Designer's E-mail Address
City State Zip F_ Telephonel
ENGINEER'S NAME Last ��� �� � / j� � First f � 1) (� L� Lic. NoT{ &*_4 'd
Engineer's Address Engineer's E-mail Address 7Z- ,Y P?
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City k UTbt,L � joy (' State -� i Zip � � 3L'U Telephone
CONTRACTOR'S NAME/COMPANY L1 Lic. No. ''��,/�3c�1t/L ClassF
Contractor's Address Contractor's E-mail Address
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SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO `DZv2I - n1al PLAN CHECK FEES $