HomeMy WebLinkAboutX2021-1520 - Permit ApplicationPunt Form '� Worksheet for Combo Building & Solar Permit Application �/
Comm'I [- Residential City of Newport Beach - Building Division A'2�4 . t9vd
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
[—Building [-Grading [-Drainage [-Elec r'Mech [-Plum cu yd cut Cu Yd Fill
Project Address (Not mailing address) [- Flood [- Fire [- Liq [- Landslide FN/A Floor Suite No
L4 u 6 boast k�M
of Work
New/AddSFF__ Remodel SFF—' Garage/New/AddF_
OWNER'S NAME Last I First
Owner's Address Owner's E-mail Address
Use Const Type
# StoriesF— # Units (if Res)
Valuation $
Material/Labor
_ -.
City State F Zip F— Telephonel—
APPLICANT'S NAME Last I First I I
Applicant's Address Applicant's E-mail Address
City State F Zip Telephonel—
ENGINEER'S NAME Last First Lic. Nof—
Engineer's Address Engineer's E-mail Address
City State Zip F TelephoneF—
CONTRACTOR'S NAME/COMPANY ApM //e /_� Lic. No. gS?000alass
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Contractor's Address Contractor's E-mail Address
City G%% /,0 State C� Zip QI 0 Telephone q0 • �pCY ...00J Y3
SETBACKS REAR
SETBACKS LEFT
1 IOC 11�1I
SETBACKS FRONT
SETBACKS RIGHT
PERMIT NO.
PLAN CHECK NO.