HomeMy WebLinkAboutX2021-2733 - Permit ApplicationPrint Form j Worksheet for Combo Building & Solar Permit Application CRO,
RraCity of Newport Beach - Building Divisionj- Comm'I F_ Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTALo„
wilding r Grading f—Drainage j—Elec rMech
Plum Cu vd Cut Cu yd Fill
F Flood r Fire F— Liq r Landslide F_N/A Floor Suite No
Project Address (Not mailingg��
/address)
Description of Work
Use Const T e
[�j� Jr� � Type vA
#Units (if Res)
# Storiesfa
�Ao
Valuation $
Material/Labor (I�
New/Add SFF Remodel SF "7� Garage/New/Add F—
OWNER'S NAME Last ;0/ A-7 �/
First
Owner's Address
Owner's E-mail Address
City State
Zip F— Telephone Ug
APPLICANT'S NAME Last ' Vf�/ /7
First
Applicant's Address
Applicant's E-mail Address
CityState /
Zip Telephone �6 Ug i1
ARCHITECT/DESIGNER'S NAME
Last �Q�y�(,yp First Lic. No.
Architect/Designer's Address 5.9.E
ArchitecUDesigner's E-mail Address
ryP�l�/G 9'�i7
City State �—
Zip F Telephoned
ENGINEER'S NAME Last JAvi
First mffoA� Lic. No. 2.
Engineer's Address
Engineer's E-mail Address
City State F
Zip TelephoneF
CONTRACTOR'S NAME/COMPANY
Lic No. F Class7
Contractor's Address
Contractor's E-mail Address
City State F_
Zip F— Telephone
SETBACKS REAR SETBACKS FRONT
I 2
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. 74
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $