HomeMy WebLinkAboutX2021-0902 - Permit ApplicationPrint Form j Worksheet for Combo Building & Solar Permit Application
F- Comm'[ r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
"j1'6uilding F- Grading r"Drainage X Elec F_ Mech
//Project
'Plum Cu Yd Cut Cu Yd Fill F _I
Address (Not mailing address) F Flood
r Fire (- Liq r Landslide F_N/A Floor Suite No
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Description of Work
Use Const Type
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#Stories #Units (if Res)�2
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Valuation F4 )U(J�
Material/Labor
New/Add SF Remodel Garage/New/Add
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OWNER'S NAME Last � � y�v�-�Lj,�((�'yL
First
Owner's Address
Owner's E-mail Address
City State F_
Zip F— Telephone L?U (03 ^ �(� 1
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APPLICANT'S NAME Last {%)1N1ayl
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First tiv
Applicant's Address
Applicant's E-mail Address
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City G �k State l Zip Gr�i..! Telephonel elzo > �(Y-,7J
ARCHITECT/DESIGNER'S NAME Last Gjel( OF Gr P�
S. � (� �` �� FirstF Lic. No.
4
Architect/Designer's Address j r
ArchitecUDesigner's E-mail Address
I
City State
Zip Telephone
ENGINEER'S NAME Last
First F— Lic. No.F
rEngineers Address
Engineer's E-mail Address
City State F_Zip F Telephone IF
CONTRACTOR'S NAME/COMPANY
Lic. No. F_— Class F_
Contractor's Address
Contractor's E-mail Address
City State Zip f - Telephone
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $