HomeMy WebLinkAboutX2021-1077 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application acs=
F_ Comm'I Residential City of Newport Beach - Building Division �( WZ� ��OTT �
NOTE: PLAN CHECK FEES nuF AT TlenF nF ci 1annirrn1
wilding F Grading [-Drainage _r Elec i-Mech F- Plum Cu Yd Cuts Cu Yd Fill F
Project Address (Not mailing address) Flood r' Fire r Liqr Landslide C -N/A Floor Suite No
Description of Work Use Const Type s-
# Stories # Units (if Res)F
Valuation $ rE
New/Add SFF— Remodel SF F77777 Garage/New/Add F— Material/Labor
OWNER'S NAME Last
�.'�(JR-3 _ First
Owner's Address Owners E-mail Address
City ja(lo- State{ Telephoner
APPLICANT'S NAME Last CV u(/U1� First
Applicant's Address
Applicant's E-mail Address
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City State Zip ( Tele
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ARCHITECT/DESIGNER'S NAME Last[ t4 G 2i
- C/� _ - First Lic. No. �—
Architect/Designees Address Architect/Designer's E-mail Address
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city y f�i State Zip G%12, Telephone _l�q�S_lc�ll�
ENGINEER'S NAME Last First Lic. No, F777
Engineer's Address Engineer's E-mail Address
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City 1 State F Zip �— Telephone[.-.--
CONTRACTOR'S
elephoneCONTRACTOR'S NAME/COMPANY �� ¢, //) C_,C7
n �J Lic, No. /70, Class
Contractor's Address Contractor's E-mail Address
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City I PT:n7iv U_rmv State Zip Q% Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $