HomeMy WebLinkAboutX2021-0842 - Permit Application (2)Worksheet for
F_ Comm'I (—'... Residential
NOTE:
Combo Building & Solar 46MZtitt4,iCityof Newport Beach - Building DivisionPLAN CHECK FEES DUE AT TIME OF SUBMITTALop„,'
Building (- Grading F -Drainage F_ Elec F_ Mech F- Plum cuvdCut s cued Fin v
Project Address (Not mailing address) F Flood r Fire r Liq F_ Landslide FN/A Floor Suite No
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F__ F 1
Description of Work
Use Const Type
# Storiess # Units (if Res)s
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Valuation $
Material/Labor
New/Add SFs Remodel SFs
Garage/New/Add F_
OWNER'S NAME Lastl Rw_r�
First �+
Owner's Address
Owner's E-mail Address
City State Zip F—' Telephoned.
APPLICANT'S NAME Last k-�Y
First _..... _ _..
Appplicant's/ Address
Applicant's E-mail Address
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City W� _.. State ��-�.:.
Zip F_e�— Telephoner
ARCHITECT/DESIGNER'S NAME Last
First Lic. No.F
Architect/Designer's Address
Architect/Designer's E-mail Address
City I State F_
Zip_ Telephone
ENGINEER'S NAMELast
First Lic. No.
Engineer's Address
Engineer's E-mail Address
City State 7_
Zip F— Telephoned
CONTRACTOR'S NAME/COMPANY Lic. No. (i e(j i [ Class 3�
``
Contractor's Address
Contralor's E-mail Address
City 1\� _. State I ('
Zip IZOU Telephone 1 t L}
SETBACKS REAR SETBACKS FRONT
PERMIT NO. ,Y 1 — 0
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $
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