HomeMy WebLinkAboutX2021-1518 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application ON
F_Comm'I F_Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F- Building r Grading j-Drainage F_ Elec F_ Mech
i- Plum CuvdCut CuYdFill F
Project Address (Not mailing address) I— Flood
j- Fire F- Liq � Landslide FN/A Floor Suite No
Seel _ yi 5--1
1 1
e/l
Description of Work
Use Const Type F
# Stories[— # Units (if Res)F
2 bed m s�� s�
Valuation $
Material/LaborF415ooK
New/Add SF Remodel SF� Garage/New/Add r—
OWNER'S NAME Last
First Y-e,_- 0
Owner's Address
Owner's E-mail Address
City State
Zip Cf 6 Telephone 7/,?/ —JS ?I
APPLICANT'S NAME Last
First
i Vwc
Applicant's Address
Applicant's E-mail Address
City State F—
Zip Telephoney - !>
ARCHITECT/DESIGNER'S NAME Last t
First /`-rC��'" Lic. No.
Architect/Designer's Address
Architect/Designees E-mail Address
3 3 014-
City `„ l State Lie
Zip G%x— Telephoned 0��
�-r[[[ �"[
GV cF`irst/
ENGINEER'S NAME Last �:ILi1� -/
/
T -�4 LicGGGNo.1
Engineer's Address
Engineer's E-mail Address
1 5-,zr C 5Y
City I ���` State
Zip F TelephoneF
CONTRACTOR'S NAME/COMPANY Lic No. Class
Contractors Address
Contractor's E-mail Address
city r 01 �0 State I & ,y
Zip F— Telephone—
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $