HomeMy WebLinkAboutX2021-1520 - Permit Application (2)Rrmt Form` Worksheet for Combo Building & Solar Permit Application
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=l Residential City of Newport Beach - Building Division M2' 1 . t��p
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
[-Building F_ Grading Drainage (-Flet (`Meth Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) f— Flood f— Fire r Liq F_ Landslide FN/A Floor Suite No
LAW ; east -
Description of Work Use F7 Const Type FI
# Stor1esF7# Units (if Res)F
_.-.._....
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New/Add SFF__ Remodel SF�— Garage/New/Add �— Valuation $ Material/Labor
OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
City I State Zip F— TelephoneF7777777
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
City State Zip �— Telephone[ . ... ..—
ARCHITECT/DESIGNER'S NAME Last First Lic. No. F_
Architect/Designer's Address Architect/Designer's E-mail Address
City State F Zip Telephonel—
ENGINEER'S NAME Last First Lic. No.F__
Engineer's Address Engineer's E-mail Address
City State Zip �— TelephoneF—
CONTRACTOR'S NAME/COMPANY pgM eCl -- // �7 Lic. No.9r�dQ�lass _I
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Contractor's Address Contractor's E-mail Address
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City G%% 1. --/•0 _ _ _ State C, %� _. Zip T I Telephone 9Q t 7 t 0 blJ Y�
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $