HomeMy WebLinkAboutX2021-2145 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application ��`W"°"a
FX_Comm'I r, Residential City of Newport Beach - Building Division — ZI q� o
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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FX,Building rGrading ;Drainage [X, Elec r7 mech FX_ Cu yd CutCu Yd Fill
Project Address (Not mailing address) FX_ r Fire r; Liq r Lan lie (KN/A Floor Suite No
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Description of Work
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# StoriesF # Units (if Res)-
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Material/Labo
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New/Add SF�--I Remodel SF iso
Garage/New/Add e/New/Add
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OWNER'S NAME Last VQ,��na(G
First og
Owner's Address
Owner's E-mail Address
City State
Zip Telephone %r��
APPLICANT'S NAME Last
First�(�
Applicant's Address
Applicant's E-mail Address
City State—
Zip I OQ,6bo Telephone
ARCHITECT/DESIGNER'S NAME ��
Last FirstU( -Lic. No.
Architect/Designer's Address
ArchitecUDesignees E-mail Address
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west c4,eNe l o rrtievll t
City /►As-"U—T' q l State 6"
Zip _,? Ts c7Telephon 1 k4,/ 6-7f _74 r,
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ENGINEER'S NAME Last j �(}�/m
v First ren Lic. No. e I
Engineer's Address
Engineer's E-mail Address
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City 6` State
Zip —(3r- Z( Telephone FQ.
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CONTRACTOR'S NAME/COMPANY
Lic. No. Class'
Contractor's Address
Contractor's E-mail Address
City State F
Zip [— Telephone
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS L FT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE bJW DEVELOPMENT NO
PLAN CHECK FEES $