HomeMy WebLinkAboutX2021-2904 - Permit Application (3)Print Form j Worksheet for Combo Building & Solar Permit Application
F_ Comm'I F_ Residential City of Newport Beach - Building Division
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL 4Fo,.s
[-Building [Grading F-Drainage F_Elec F_Mech F7Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) F_ Flood r Fire F7 Liq F_ Landslide FN/A Floor Suite No
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Description of Work
Use Const Type
# StoriesF— # Units (if Res)
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Valuation $
Material/Labor
New/Add SF F_Remodel F77777 Garage/New/Add F
OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
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City State Zipl— Telephone S0�'6-040
APPLICANT'S NAME Last rs-i9" IN_First Te,(
Applicant's Address Applicant's E-mail Address
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City State Zip Telephon 4 0 9) 3g� _ LltP9 d
ARCHITECT/DESIGNER'S NAME Last Tt� IogS S I First Mp+r v1 Lic. No. �—
Architect/Designer's Address Architect/Designer's E-mail Address
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City State I `-r Zip Telephone q _5 u
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ENGINEER'S NAME Last First Lic. No.
Engineer's Address Engineer's E-mail Address
City— State- ZipF— Telephone
CONTRACTOR'S NAME/COMPANY -`�N�. Co j cjI �o Lic. No. ST) Class
Contractor's Address Contractor's E-mail Address
City State F Zip— Telephone oq�gg0_L,(�tfiy
SETBACKS REAR SETBACKS FRONT PERMIT NO. v CXJ t/j\ 2
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $