HomeMy WebLinkAboutX2021-0921 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
j Comm'I F Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F_Building F_Grading (Drainage I-Elec (-Meth FPlum cuvdCut F----
Cu Yd Fill
Address (I
19-6 2
of Work
New/Add SF F—
mailing address) r Flood j- Fire r Liq f- Landslide rN/A Floor Suite No
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Remodel SF
COr,-er {—ve�4+
Garage/New/Addl
Use ConstType
# Stories[— # Units (if Res)[ —
Valuation $ y
Material/Labor F, Yi0
OWNER'S NAME Last �
�� .e.�_ First
OwnerFT-'s Address
Owner's E-mail Address
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City �Ij State Zip Telephone ` 1 4,i .S— l
APPLICANT'S NAME Last F
Vv�Gl�l� First�lr
Applicant's Address Applicant's E-mail Address
City ! State C N: Zip !Ul Telephoner o'1S--
ARCHITECT//DiESIGNER'S NAME
• �"���� to F�r`tt-$r-+�—.—�.�.� b-�ie.No.
Architect/Designer's Address Architect/Designer's E-mail Address
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ENGINEER'S NAME Last F---g o S �•I First Lic. No.
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Engineer's Address Engineer's E-mail Address
City ��. f �o s� State � i� i- Zip q (, 3 7 Telephone j PI-�
CONTRACTOR'S NAME/COMPANY TLPryl �.e_rLic. No. 60ass
Contractor's Address Contractor's E-mail Address
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City I Q V 2 State F�-- Zip 9� 3 Telephone
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE _ , _ _ DEVELOPMENT NO
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEES $