HomeMy WebLinkAboutX2021-2355 - Permit Application1 _Print Form _I Worksheet for Combo Building & Solar Permit Application
Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
(XBuilding FX Grading FXDrainage rX Elec FX Mech (X Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) r Flood Fx_ Fire r Liq rX Landslide (XN/A Floor Suite No
T OR wall
Description of Work
Use VConst Type I V J
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# Stories # Units (if Res)F—
Valuation$
Material/Labo
New/Add SF q Remodel S Garage/New/Add
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OWNER'S NAME Last Firsl7-,- 7 A1V'��
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Owner's Address Owner's E-mail Address
City Q9 �State � Zip Telephone o L� 5� 2- -7
APPLICANT'S NAME Last /r�� �� First
Applicant's Address Applicant's E-mail
?Address
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City State Zip ! Telephon Z-z 77t�
ARCHITECT/DESIGNER'S NAME Last First F Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State F_ Zip F— Telephoned
ENGINEER'S NAME Last First Lic. NI al `(l I.,, o
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Engineer's Address ` Engineers E-mail Address
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City State Zip I TelephoneF_
CONTRACTOR'S NAME/COMPANY ,ry/ l Lic. No. lass
Contractor's Address Contractor's E-mail Address
City U State 71 t ZipFc�i_i Telephone 71y
3 z -71
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SETBACKS REAR S SETBACKS FRONT PERMIT N0. 21
SETBACKS LEFT SETBACKS RIGHT 3i PLAN CHECK N0.
USE ZONE 2 DEVELOPMENT NO PLAN CHECK FEES $
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