HomeMy WebLinkAboutX2021-0922 - Permit ApplicationPrint Form I '" Worksheet for Combo Buildin & Solar Permit Application
(— Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) I— Flood F- Fire r Liq F_ Landslide rN/A Floor Suite No
Description of Work
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# Storiess #Units (if Res)s
Valuation a
Material/Labor
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OWNER'SNAME Last First + E7
Owner's Address Owner's E-mail Address
City State Zip q Telephone r(l �G�2 Z7�a
APPLICANTS NAME Last 1-14l7-6,U First v,-T
Applicant's Address Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last �l�V�. � R� � � First Lic. No.f-_
Architect/Designer's Address Architect/Designer's E-mail Address
City State F_ Zip F_ Telephoned
ENGINEER'S NAME Last First F Lic. No.s--
Engineer's Address Engineer's E-mail Address
City State �_ Zip F_ Telephoned
CONTRACTOR'S NAME/COMPANY IG rl �N t (S Lic. No. Z& 17 � Class r7
Contractor's Address Contractor's E-mail Address
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SETBACKS REAR SETBACKS FRONT PERMIT NO.
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SETBACKS LEFT i) SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES
Print Fo m Worksheet for Combo Building & Solar Permit Application o�E., *,
FComm'I esidential City of Newport Beach - Building Division p
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL G<",,.+��
Building Grading Drainage (-Elec Mech rPlum cuvdCut cuydFiuF
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Project Address (Not mailing address) F7 Flood f Fire F_ Liq f Landslide F_N/A Floor Suite No
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p F'(�cx i 30��.WZDescrr tion of Work
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oriesl# Units (if Res)F
tValuation
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RemodelSFFGarage/New/AddF-erial/Labor
OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
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City G 1N\ Statei_
Zip Telephone
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last CJ� A S,- FARUCA, '1"st Lic. No. �—
Architect/Designer's Address Architect/Designer's E-mail Address
City State F— Zip I Telephone=
ENGINEER'S NAME Last First F Lic. No.�—
Engineers Address Engineer's E-mail Address
City State �— Zip TelephoneF
CONTRACTOR'S NAME/COMPANY i?t '�dt 1 � l>,pr(_tom Lic. No. '7 �z6 Class
t wContractor's
Contractor's Address E-mail Address
City U P(AA-) State— Zip i/7G "i Telephone C(Q- h �S':2�J�Z'
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $