HomeMy WebLinkAboutX2021-3023 - Permit ApplicationL Print Form j Worksheet for Combo Building & Solar Permit Application �EWPoq,
j- Comm'I r- Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES nl IF AT TIME nF ai 1PftA=A1
F—Building F_ Grading r-Drainage f—Elec F_Mech j"plum CuYd Cut F_Cu Yd Fill F_
ProjectAddress (Not mailing address) i— Flood F_ Fire f— Liq f Landslide I —N/A Floor Suite No
Description of Work
Use I— Const Type F_
# StoriesF_ # Units (if Res)F—
Valuation $
Material/Labor v
New/Add SF Remodel SF �— Garage/New/Add �—
OWNER'S NAME n ,
Last �l `�`�.J First
4'
Owner's Address Owner's E-mail Address
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S CO)C�"
City State �—
Zip I ) Telephone C-FCt 2 q yl
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APPLICANT'S NAME Last q
1 \l l L First I
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Applicant's Address
Applicant's E-mail Address
City State Zip F— Telephone—
ARCHITECT/DESIGNER'S NAME Last First F_
Lic. No. �—
Architect/Designer's Address Architect/Designer's E-mail Address
City State �— Zip F— Telephone —
ENGINEER'S NAME Last } , (�) First UC 1 Lic. No. �o
C, J
Engineer's Address Engineer's E-mail Address
City F State F Zip Telephoner
CONTRACTOR'S NAME/COMPANY Lic. No. �— ClassF_
Contractor's Address Contractor's E-mail Address
City State F Zip Telephone -,
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO, 2U- 2 E'
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $