HomeMy WebLinkAboutX2021-2978 - Permit Application-,-Print Form__ Worksheet for Combo Building & Solar Permit Application
Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMI`17M
)uilding [Grading [—Drainage F_ Elec F_ plum (—'Meth F—
_4 -- Cu Yd Cut Cu Yd Fill F
Project Address (Not M21111ing address) F_— Flood F—, Fire F_— Liq F_ Landslide FN/A Floor Suite No
F
Description of Work Use ConstType
41rk0 Le, kj (f,
ii # Stories # Units (if Res)
F 7
IValuation
New/Add SF Remodel SF Garage/New/Add Material/Labor 1�00
OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
City
State zip Telephon
APPLICANT'S NAME Last&pu ! First by
...... ..... P 1
Applicant's Address Applicant's E-mail Address
1_76W__
City F,�f
6;F)r� Zip Telephone
State F 2>&t -<��LALJ
I - __ ___ - lq-
ARCHITECT/DESIGNER'S NAME
Last First Lic. No. F77777
- - --------
Architect/Designer's Address
City State
- - ---------- _7
Architect/Designer's E-mail Address
Zip F7777 Telephone[, ---,-.,---
Last First[ Lic. No. F_____ qr_
Engineer's Address
City State F®
Engineer's E-mail Address
I— ------ -- ------- -- --- ------- I - ---- - - - - ------- -------- __ .. _...._.._:..--
Zip [ - - - Telephonel
CONTRACTOR'S NAMEXOMPAINYL<;Lic. No. Class e
7 OW-,
Contractor's Address
City kwo I V L_ State FCT7
SETBACKS
SETBACK LE
ISE ION &j
SETBACKS FRONT
SETBACKS RIGHT
DEVELOPMENT NO
Contractor's E-mail Address
Zip[ Telephone[�� L4 2,
PLAN CHECK NO.
PLAN CHECK FEES $