HomeMy WebLinkAboutX2021-3413 - Permit ApplicationPrint Form �// Worksheet for Combo Building & Solar Permit Application >WP6
r Comm'I (`i/Residential City of Newport Beach -Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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j-Drainage j-Elec j—Mech F'-Plum Cu Yd Cut
Cu Yd Fill
Project Address (Not mailing address) r- Flood F- Fire F Liq F_ Landslide 5<�/A Floor Suite No
Description of Work
— _ Use F— Const Type
St i?t--c IL �X T-� 'Sirnr
# StoriesF_ # Units (if Res)F_
Material/La
New/Add SF� Remodel SF�— Garage/New/Add �— Valuation $
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OWNER'SNAME Last
_��\ � -Zt ,�'- First.. JC`'C j1 f 1
Owner's Address
Owner's E-mail Address
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Cityit -- - �'F �7iy24 Teleph ILC_�
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State �—
zip�— Telephone
APPLICANT'S NAME Last //\.,f
/I First )� '
Applicant's Address - -
2- ' ( Applicant's E-mail Address
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City '[�c L rl� j State Zip 2 Telephone jic, i/ �, e: 1 `
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ARCHITECT/DESIGNER'S NAME
Last First �—
Lic. No. F—
ArchitecUDesigner's Address Architect/Designer's E-mail Address
-- _ � �— �—
City State
Zip Telephone
ENGINEER'S NAME Last
First Lic. No.�
Engineer's Address Engineer's E-mail Address
City State —
ZiP F— TelephoneF�
CONTRACTOR'S NAME/COMPANY
Lic.No. �— Class F_
Contractor's Address Contractor's E-mail Address
City State r— Zip [_ Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO. i/l (� I
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK N0. L ol,
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $