HomeMy WebLinkAboutX2021-0998 - Permit ApplicationX 2001
Print Form Worksheet for Combo Building & Solar Permit Applicatig r of P
F- Comm'I (- Residential City of Newport Beach - Building Division d
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL ���
F-Building g g r r Cu Yd Fill F
Buildin Gradin Oraina a Elec Mech Plum cu i
Project Address (Not mailing address) f -I Flood f- Fire F_. Liq F_ Landslide F_N/A Floor Suite No
Description of
UseConst Type
¢3��
Work
I - F',
# Stories'1—#Units (if Res)F1_
Valuation $
Material/Labor
New/Add Sri Remodel SF l Garage/New/Add
OWNER'S NAME Last Fir
Owner's Address Owner's E-mail Address
city �/Fil.✓%!O/.� State _? Zip G�� - _� Telephone �tj�j_.'7-10%%L�
APPLICANT'S NAME Last (,/V- Firs
Applicant's Address Applicant's E-mail Address..
City State �— Zip_ Telephon .I� G67* ,GG
ARCHITECT/DESIGNER'S NAME Last First F Lic. No. r �
Architect/Designer's Address Architect/Designer's E-mail Address
City State Zip Telephone)
ENGINEER'S NAME Last First f -- Lic. No.1
Engineer's Address -- - - - - --- -Engineer's E-mail Address -
City State Zip Telephoner
CONTRACTOR'S NAME/COMPANY // //// Lic. No. G-��G-t Class
04rfn s - I/ g I E
Contractor's Address Contractor's E-mail Address
4S/ /9d✓%yG�/
City h State FCv - Zip qak� Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $