HomeMy WebLinkAboutX2021-3419 - Permit Application"Print Form Worksheet for Combo Building & Solar Permit Application ��`W °
[- Comm'] r Residential City of Newport Beach - Building Division Uzi�1J 1 `(1 0
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL Ll'1 �oa,�'
Building [Grading
F -Drainage
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Project Address (Not mailin
address) r Flood j- Fire r Liq ', Landslide rN/A Floor Suite No
Description of Work
Use Const Type
MN
#Stories ! #Units (if Res)
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Mate Valualal/Labor F.
New/Add SFJ �j I Remodel SFF— Garage/New/Add �—
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OWNER'S NAME
Last
First
Ow er'sAddress
Owner's E-mail Address
City F-MMUt
I
State ' Or 1 Zip I l aphonel
APPLICANT'S NAME
Last
.... -.. - -. First I
Applicant'q Address
Applicant's E-mail Address
i
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Cit Y
State Zi �
p Telephone
ARCHITECT/DESIGNER'S NAME Last
__ _5-
First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City I,
`—
State Zip F—Telephoner
ENGINEER'S NAME
Last I
First F_ Lic. No.F_,
Engineer's Address
Engineer's E-mail Address
City �—
.__.__.
State F Zip F Telephoner—
CONTRACTOR'S NAME/COMPANY
Lic. No. Class `
Contractor's Address
Contractor's E-mail Address
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vl� C IyLLV l/ P ��1,1 ✓�V
City 1.
Stateof Zip U Telephoner_"
SETBACKS REAR
SETBACKS FRONT PERMIT NO. �,(o/�W/ ° '✓`9'Q' tl
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. /e- f '® 'Tom
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $
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