HomeMy WebLinkAboutPV2021-149 - Permit Application�_Pnnt Form j Worksheet for Combo Building & Solar Permit Application
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F_ Comm'I r Residential City of Newport Beach - Building Division °% 1 o �I , � y41
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL c _a,11
[-Building rGrading rDrainage rElec rMech F- Plum CuvdCut l Cu Yd Fill
Project Address (Not mailing address) r Flood r Fire r` Liq r Lalndslide rN/A Floor Suite No
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Description of Work Use Const Type
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# Stories #Units (if Res)
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New/Add SF�— Remodel SF�— Garag valuation $ a/New/Add �— Material/Labor
OWNER'S NAME Last A -r o n o"'o i First
Owner's Address Owner's E-mail Address r'q
City Q yr 1� Gh State _ ✓� ZipP Tele hone
p x/71 i-01 ,73ZSZ
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
City State r_ _.
Telephone
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ARCHITECT/DESIGNER'S NAME Last First �—
_ Lic. No.
Architect/Designers Address
9 Architect/Designees E-mail Address
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city State F Zip F , � — TelephoneF-7777
ENGINEER'S NAME Last First Lic. No.F
Engineer's Address Engineer's E-mail Address
City State Zip Telephoner
CONTRACTOR'S NAME/COMPANY Lic. No. g9 Z2s, Class /o
Contractor's Address Contractor's E-mail Address
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City �
Sr�_r�4 I , 1 f State C"�.. zip _ 9 is' Telephone '{ (Z "Y
SETBACKS REAR SETBACKS FRONT PERMIT NO. ?V JOS I m t°
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. q Z,7)
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $