HomeMy WebLinkAboutX2021-2912 - Permit Application (2)Print Form Worksheet for Combo Building & Solar Permit Application oozl_�
F Comm'I r -Residential City of Newport Beach- Building Division X%2 P Zal E
I
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL ( Oil
1VBuilding F_ Grading F -Drainage [Flet
F_ Mach rPlum Cu yd cut Cu Yd Fill F
Project Address (Not mailing address) F__ Flood F_ Fire F_ Liq F- Landslide F_NIA Floor Suite No
J4q7
New/Add SFF __ Remodel SF F_ Garage/New/Add
OWNER'S NAME Last
Owner's Address
I_! - 14?4,7 -kedvard one
First
Use Const Type F
# StoriesF_ # Units (if Res)F
luation $F7
IVa
Material/Labor
Owner's E-mail Address
. ............ .... ... ... ..... . - - -----
State
City ..... . .... ZiPF(72
tr7-
,Z,0 Telephone[
APPLICANT'S NAME Last
Applicants Address
. .. .... ......... .. . .. .... .
City State
First
Applicant's E-mail Address
- --------- -
Zip Telephoned
ARCHITECT/DESIGNER'S NAME Last I First F_ Lic. No. I
Architect/Designers Address
I... .... ..
city 1- State F
Architect/Designer's E-mail Address
I—, - - - __ - - ----- -------- - - -----
Zip F—
----ZIPF— Telephoner
ENGINEER'S NAME Last First 7 r
F91tdt"Ird - d Lic. No. F7Y,903
Engineer's Address
no -t- .... Ave
City I _A(Wv,,tw- State Fell
Engineer's E-mail Address
Zip [ 612-607 TelephonelN.636-6/�
CONTRACTOR'S NAME/COMPANY
Lic. No. Class
Contractor's Address
NPA 7`0 5+
City 16PA State
SETBACKS REAR SETBACKS FRONT
Contractors E-mail Address
Zip../ Telephone
F;/rf 3-
�&Gv_ 01a W
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $