HomeMy WebLinkAboutX2021-0186 - Permit ApplicationPrint Form' Worksheet for Combo Building & Solar Permit Application
r Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building F- Grading rDrainage FElec (--Mech F- Plum Cu rd Cut r Cu Yd Filly
Project Address (Not mailing address) I- Flood r- Fire r- Liq j-" Landslide rN/A Floor Suite No
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I F_
Description of Work
Use I Const Type
F( Qe- e-- I )a ii (). 'G✓'
112 '6 l°'t
A
#Stories #Units (if Res)
r piv I}I°) C Z -ry S PC: 4
New/Add SF N A Remodel SF N 4
Garage/New/Add N ✓a
Valuation $ I(�
Material/Labor) (a ^ V
OWNER'S NAME Last
First I & N ?�
Owner's Address
Owner's E-mail Address
City F c: v o PA ,\ �� / _ m ci r State I `
Zip G Telephone q_� q _ 3 � t/ - -�Li 3 .
APPLICANT'S NAME Last I��_
_ First r
Applicant's Address 0 t-3 iu L'
Applicant's E-mail Address
City F_State F __'_
Zi Tele P F -,Phone F__
ARCHITECT/DESIGNER'S NAME Last f --_ V� First [_ Lic. No. r_
Architeect/Designer's Address
Architect/Designer's E-mail Address
City I State F...______'
Zip r_ TelephoneF_
ENGINEER'S NAME Last ,First [_ Lic. No.[ -
Engineer's Address
Engineer's E-mail Address
City F_ State r W
Zip Telephoner
CONTRACTOR'S NAME/COMPANY
Lic. No. r--' �- Class
Contractor's Address
Contractor's E-mail Address
City r-i�- �, State
Zip F Telephoner
SETBACKS REAR SETBACKS FRONT
PERMIT NO. U
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK N0.
USEZONE DEVELOPMENT NO
PLAN CHECK FEES$