HomeMy WebLinkAboutP2021-0291 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application a
r Comm'I r Residential City of Newport Beach - Building Division {�lNOTE: PLAN CHECK FEES DUE AT TIMF OF RI IRMITTDI t GZcI
F-Building r' Grading (-Drainage I- Elec r Mech r Plum CuvdCut F_ CuYdFill F_
Project Address (Not mailing address) r Flood r Fire r Liq r Landslide rN/A Floor Suite No
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Description of Work
C. K L
Use F Const Type
# StoriesF # Units (if Res)F_
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Valuation $Material/Labor)
New/Add SF�^� Remodel SFF—
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Garag New/Add
OWNER'S NAME Last ��
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First j)-i✓ IIL7h t; �,- -
Owner's Address
Owner's E-mail Address
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City ,P�;�`>
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State t
Zip��, , Telephoned
APPLICANT'S NAME Last
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First (-_�f�Gt/\-_
Applicant's Address
Applicant's E-mail Address
City Z(S
State _
Zip Telephone[7]1 L! - Cj 7, - LI 1,Lj
ARCHITECT/DESIGNER'S NAME
Last First Lic No. �—
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State �
Zip F_ TelephoneF_
ENGINEER'S NAME Last
First F_ Lic. No.F_
Engineer's Address
Engineer's E-mail Address
City F
State F—
Zip � Telephoned
CONTRACTOR'S NAME/COMPANY
1 Lic. No.
j�,,_i��^✓• 1``.t.i r (� ��� `LJ� (.J �`i Class
Contractor's Address
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Contractor's E-mail Address
City
State (� IJT
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Zip «,�. n Telephone[
SETBACKS REAR
SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO. Z I O li s ?,n
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $