HomeMy WebLinkAboutX2021-2323 - Permit Application (2)Print Form Worksheet for Combo Building & Solar Perm't Application @N-3,
" °RaF_ Comm'I j— Residential City of Newport Beach -Building Division�o�%� „�QNOTE: PLAN CHECK FEES DUE AT TIME OF SUB 21
rBuilding F_Grading Drainage rElec F'Mech F==Pldm Cu yd CutCu Yd Fill
Project Address (Not mailing address) [ Flood r Fire r Liq r Landslide rN/A Floor Suite No
Description of Work
Use l Const Type
LV I
# Stories # Units (if Res)s
Valuation $
Material/Labor
New/AddSFF_ Remodel SF Garage/New/Add—
OWNER'S NAME Last C 1O `MAA First
Owner's Address Owner's E-mail Address
City State I Zip �i Telephoner
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Addres
City State �— ZipF— Telephone'i�}
ARCHITECT/DESIGNER'S NAME Last First F Lic. No. F
Architect/Designer's Address Architect/Designer's E-mail Address
City State F Zip F Telephoned
ENGINEER'S NAME Last F First F Lic. No. F—
Engineers Address Engineer's E-mail Address
City State Zip Telephone—
CONTRACTOR'S NAME/COMPANY � � Lic. No. q1 pzi' q Class
Contractor's Address Contractor's E-mail Address 75,3W r,; 270 015-
City State F Zip F Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO. xm( s Vs L3
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $