HomeMy WebLinkAboutX2021-1035 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
j Comm'I (— Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SURMITTAI
F -Building Grading
F -Drainage F_Elec FMech f— Plum Cu Yd Cut Cu Yd Fin
Project Address (Not mailing address) r Flood 7_ Fire F7 Liq [-= Landslide F_N/A Floor Suite No
�j22 S l/1/l a �k� -r v✓ 6AUd• IV- r_..®_. -
Description of Work
Use F—ConstType F_
# Storiesr— # Units (if Res)r`
Valuation $
Material/Labor
New/AddSFr----
RemodelSFrGarage/New/Add r- --
OWNER'S NAME
Last '-
First
Owner's Address
Owner's E-mail Address
City—
.State Zip L_ —. Telephone—
APPLICANT'S NAME
Last r- — —
First
Applicant's Address
Applicant's E-mail Address
City
State �— Zip �--- Telephone[—
ARCHITECT/DESIGNER'S NAME Last �— Flrst r ---
Lic No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City I----_
_- State F_-- Zip L-- Telephoner----_
ENGINEER'S NAME
Last First r------ Lit. No.r--
:Engineer's Address
Engineer's E-mail Address
City
State F---- Zip I— Telephone��
_
CONTRACTOR'S NAME/COMPANY y Lic.Fe _i5
Contractor's Address
Contractor's E-mail Address
8'`�?j ov✓t
City
((
:� W �'TC ar5e& GA S$�s/11vjJ. h e�
State `J'�%02..
n(��s
Zip Telephone i�� 4.-q"'(0'Zs G,
SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $