HomeMy WebLinkAboutX2021-0717 - Permit ApplicationPrint Form Worksheet or Combo Building & Solar Ve mit Application
F Comm'I KResidential City of Newport Beach - Building Division �/�
OTE: PLAN CHECK FEES DUE AT TIME OF SUBMITPL "
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wilding j_ Grading Xr
ainage �Elec j>$/lech lum cu vd cut Q�fi -. -cu vd Fill
Project Address (Not mailing address) f Flood f— Fire XLiq r' Landslide [_N/A Floor Suite No
Vie �---
scription of Work
C) I New/Add SF
Remodel SF
Garage/New/Add
Use F—ConstType
7777
# Stories -_4 Units (if Res)
Valuation $ 2
Material/Labor J� 3
OWNER'S NAME � "`- - - -
Last First
Owner's Address
Owner's E-mail Address
G V��C-
city State F2�;P7
Zip Telephon
APPLICANT'S NAME Last
First
Applicant's Address Applicant's E-mail Address
A
City 4/ Y State I 1 Zip ��� TelephonD
ARCHITECT/DESIGNER'S NAME1. Last '
(� First Lic. No.
Architect/Designer's Address Arch itect/Designer's E-mail Address
city �
State Zip 1 46� Telephon / 7
ENGINEER'S NAME Last �^� _I '` First �FZ '
ca' , CJ !�/� Lic. No. �
Engineer's Address Eng' eer's E-mail Address
VA1+ Jo_ ea__ W)
City ����^, State4 rs - Zip i�,7pl Telephon j7 33C` L�
vvrl I� V" ! I1.L
CONTRACTOR'S NAME/COMPANY AP14
/'e�e^ � � Lic. No.WnnZ Class
Contractor's Address Contractor's E-mail Address
City State F�X— Zip q ,� TelephonEL�tpG) 5 j_ 1r�)
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
PERMIT NO.G'
USE ZONE
SETBACKS RIGHT
DEVELOPMENT NO
PLAN CHECK NO.
PLAN CHECK FEES $