HomeMy WebLinkAboutX2021-3368 - Permit ApplicationPrint Form7l Worksheet for Combo Building & Solar Permit Application
F_ Comm'I F_ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
[—Building F_ Grading [—Drainage [_ Elec j" Mech Plum Cu Yd Cut F_
Cu Yd Fill
Project Address (Not mailing address) F_ Flood Fire [_ Liq F Landslide F_N/A Floor
Description of Work
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New/Add SF Remodel SF F (, Garage/New/Add
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Suite No
Use F—Const Type
# Stories °; - # Units (if Res)I
Valuation $
Material/Labor ��11�00,
OWNER'S NAME Last First F 3��
Owner's Address Owner's E-mail Address
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City State F6 Zip Telephone q qq . Cl2Z , go51
APPLICANT'S NAME Last I����
Applicant's Address
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City F,51aJ CLVIO_
First
Applicant's E-mail Address
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State F Zip 4217?2, Telephone ct", 533,-r79 (0
ARCHITECT/DESIGNER'S NAME Last F First /�
�—' ( Lic. No.
Architect/Designer's Address Arch itect/Designer's E-mail Address
Cites � F l07 Telephone
Y State Zip hones-33 ,77
ENGINEER'S NAME Last First Lic. No. C 5�� gp
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Engineer's Address Engineer's E-mail Address
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City �p,c� 4� State Zip �Zlv�� Telephone
CONTRACTOR'S NAME/COMPANY 0,` 1 Lic. No. i (o7300 Class
Contractor's Address Contractor's E-mail Address
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City S C.1�1 � FjU—�—j= State Zip Gi^Z�o%3 Telephone ' '7" `50,j_3 - —77 ztl
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
PERMIT NO. _&-
PLAN CHECK NO.
PLAN CHECK FEES $
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