HomeMy WebLinkAboutX2021-2552 - Permit ApplicationPrint Form ,] Wo eet for Combo Building & Solar Permit Application 1 WPOgO
F_ Comm'I r Residential City of Newport Beach -Building Divisionn�% I ��
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITUA
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Building F_ Grading Drainage Elec F_Mech r—,PlumCu Yd Cut F_Cu Yd Fill
Project Address (Not mailing address) F Flood j— Fire F_ Liq [N/A Floor Suite No
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Description of Work
Use onstType \/ 6j
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# Stories # Units (if Res)
Valuation $ Oc) , CD
Material/Labor /
New/Add 5F� Remodel SF ®� Garage/New/Add �—
OWNER'S NAME Last �( t 4 First
Owner's Address Owner's E-mail Address
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City 1 State ZipC� os Telephone
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APPLICANT'S NAME Last _ First
Applicant's Address Applicant's E-mail Addre
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City State ��� ,��— Zi
#✓�C p _ �( . "-Telephone 4W z -71 3 D
Last C I First Lic. No.
Architect/Desii er's Address Architect/Designer's E-mail Address
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City State Zip Telephone � Z�, -7
ENGINEER'S NAME Last First Lic. No.�—
Engineer's Address Engineer's E-mail Address
—
City F-7 State Zip I-- TelephoneF
CONTRACTOR'S NAME/COMPANY Lic. No. 7966 59 Class
Contractor's Address Contractor's E-mail Address
City State �— Zip Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $ R