HomeMy WebLinkAboutX2021-1670 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application as,
Cit of New ort Beach - Buildin Division
Comm I r Residential NOTE: PLAN CHEK FEES DUE AT TIME OF SUBMITTAL
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Building Grading
F -Drainage F_ Elec F Mech j` Plum CuvdCut r Cu Yd Fin s
Project Address (Not mailing address) f-= Flood F_ Fire F_ Liq f— Landslide F_N/A Floor Suite No
Description of Work
Use I Const Type F_
- ° i l
# Stories # Units (if Res)r—
c4DC)
g i y Pa/�py
Q
`®
�✓ �f h I �✓'"
0 4
Valuation $
Material/Labor 51VVi1
r
New/AddSF�----
Remodel SFr-- Garage/New/Add 4
OWNER'S NAME
Last First
Owner's Address..
Owner's E-mail Address
.City _._
_. State r--.. Zip r--�-�— Telephone—
APPLICANT'S NAME
Last r First
Applicant's Address
Applicant's E-mail Address
City I
State F_ Zip r-- TelephoneF—
ARCHITECT/DESIGNER'S NAME. Last First r Lic. No. F_
Architect/Designer'sAddress
Architect/Designer's E-mail Address.
City
State I — Zip F — Telephoner
ENGINEER'S NAME
Last First r--- Lic No.jr
Engineer's Address
Engineer's E-mail Address
City _
State r — Zip -- TelephoneF
CONTRACTOR'S NAME/COMPANY' ( Lic. No. t(�)7S7f ClassF
E41 IRs `wfc. � Y.,eC ,s
Contractor's Address
Contractor's E-mail Address
r),o � c. fi C�K4 . 54 zzO 66be-
City f`� �� State � Zip (sco Telephone RI 600 c'
^i - 61
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SETBACKS REAR
SETBACKS FRONT PERMIT NO. )(-'Z(:>' u— 16 bCt
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO O 'Z-b;'iOA PLAN CHECK FEES $