HomeMy WebLinkAboutPV2021-173 - Permit ApplicationLPrint Form g Worksheet for Combo Building & Solar Permit Application
F_ Comm'I F? -4, Residential City of Newport Beach - Building Division P4202.1 —I zt,3
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F—,Building [Grading F_,Drainage F,_ Elec F. Mech f— Plum Cu Yd CutF—Cu Yd FiIIF_
Address (Not mailing address) F Flood F_ Fire f—, Liq F_ Landslide F_.N/A Floor Suite No
DT_ Ha6D-ef s -p -r- ...............
)n of Work Use F-11 Const Type F-1,
KC0 I
Cf .1 # StoriesrF # Units (if Res)F7
Valuation $
New/AddSFI------ . .. .... Remodel SFF77777 Garage/New/AddF IMaterial/La
OWNER'S NAME Last
Owner's Address
City
State F
APPLICANT'S NAME Last
Applicant's Address
City State
First
Owners E-mail Address
Zip
First
Applicants E-mail Address
Zip Telephone[Nq
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City [ -------- -- -- State zip TelephoneF
ENGINEER'S NAME Last First Lic. No.
Engineers Address
city State(
Engineers E-mail Address
ZIP TelephoneI-, C305 -3zz, -
CONTRACTOR'S NAME/COMPANY I
Lic. No.
jo
Contractor's Address
- ez�o
City 7t .Vt State
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
Contractor's E-mail Address
F_cc_,�erW . lt�d_5un - CC)Mr
Zip 2-&14- Telephone 4
PERMIT NO.
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
&M,