HomeMy WebLinkAboutX2021-0112 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application o4 E"^ra
Comm'I r Residential /
City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBAL.,,
Building r G ding r inage Elec r Mech
r Plum Y_
uvd t i� CuYdF j ��
Project Addr 55 i address) Flood
_Cu
Fire j Liq j L `` ' e FN/A Floor
F:-
Description of Work ,) c 'a
KJse K ConstType FvP7
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# Stories # Units (if Res)[
LA 9 AC
Valuations
Material/Labor
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New/Add SF F } Remodel SF 4.�i1. Garage/New/Ad
OWNER'S NAME Last ,;;ti�,�r
First �sa c7,-.1�-
Owner's Address
Owner's E-mail Address
City }\ State
Zip Telephone
APPLICANT'S NAME Last f'�, C_vo /�
First
Applicant's Address
Applicant's E-mail Address
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City C C> State r
Zip Telephone �LAc�
ARCHITECT/DESIGNER'S NAME Last
First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
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City 1P1� State
Zip Telephone�� _2�
ENGINEER'S NAME Last r
First F_ Lic. No.F_
Engineer's Address
Engineer's E-mail Address
City � State F_
Zip F— Telephone[�
CONTRACTOR'S NAME/COMPANY r [fr '� ; \
1.' I.7••� 1
1 r,G Lic. No. /0(„)q(j� Class3
Contractor's Address
Contractor's E-mail Address
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City },� �y State e
Zip gZG;-7 Telephone iq 9 yyJ-96Z6
ETBACKS R SETBACKS FRONT
PERMIT NO. Xjt
S TBAC L ti SETBACKS RIGHT
•O� -"�
PLANCHECKNO.
USE Z E4 DEVELOPMENT NO
PLAN CHECK FEES $
1 Print Form I Worksheet for Combo Building & Solar Permit Application o�EW�am
[X Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL s
iX`Building (X Grading rDrainage IX Elec FX_ Mech
FX- Plum Cu yd Cut Cu Yd Fill F
Project Address (Not mailing address) FX_ Flood Fx Fire FX_ Liq r Landslide FX_N/A Floor Suite No
DescriptioofI�Work
UseF—ConstTypeF—
# Stories # Units (if Res)[—
Va ation $
Mterial/La f
New/Add SF�� RemodelSFF Garage/New/Add��
OWNER'SNAME Last—
First
Owner's Address
Owner's E-mail Address
City F_
State �
Zip F— Telephoned
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City
State F_
Zip �— Telephoned
ARCHITECT/DESIGNER'S NAME
Last �— First I Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State F—
Zip I Telephone
ENGINEER'S NAME Last
First � Lic. No.F—
Engineer's Address
Engineer's E-mail Address
City
State F—
Zip Telephonel�
CONTRACTOR'S NAME/COMPANY
Lic. No. ClassF—
Contractor's Address _
Contractor's E-mail Address
City
State
Zip Telephoned
SETBACKS REAR
SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $