HomeMy WebLinkAboutX2021-1321 - Permit ApplicationPrintForm , Worksheet for Combo Building & Solar Permit Application V a
ential 2 l City of Newport Beach - Building Division r'.�
Comm I Resi ential 9 g %Ci S�
NOTE: PLAN CHECK FEES DUE AT TIMF nF .Si IRNnITToi 1 Za U a ��l ri
F`Building F_GradingF-Drainage j-Elec !-Meth F- plum CuYdCut F CuYdFit
Project Address (Not mailing address) f Flood r Fire F Liq j- Landslide I -N/A Floor Suite No
Description of Work Use F_ Const Type F_
# Stories[ # Units (if Res)[
Valuation $
New/Add SF�- Remodel SFF ---- Garage/New/Add -- Material/Labor 2° 8 O )�
WNER'S NAME Last _ 11
loe� �W Pov� First
Owner's Address i7Owner's -mail Address
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Zip [ TelephoneF?- y1 6 33 2-
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
City State � Zip F— TelephoneF_
ARCHITECT/DESIGNER'S NAME Last First F_
Lic. No. F_
ArchitecUDesigner's Address Architect/Designer's E-mail Address
City State Zip 1 Telephone!__
ENGINEER'S NAME Last First
Lic. No.F—
Engineer's Address Engineer's E-mail Address
City W State Zip �— Telephoneli.—
CONTRACTOR'S NAME/COMPANY
U00AK .v _ '�� �� Lic No. jn0 SO 45 Class
Contractor's Address ,t Contractor's E-mail Address
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City FT�JetAa State C/4- Zip �//0-- Telephone((0) $,302
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
DV.