HomeMy WebLinkAboutX2021-2569 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
r Comm'I ( Residential City of Newport Beach - Building Division Y V (Wag
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITfAu
r-Building [_ Grading r==Drainage i-Elec rMech
F= Plum Cu vd Cut Cu Yd Fill s
Project Address (Not mailing address) F_ Flood
F— Fire r Liq F_ Landslide F N/A Floor Suite No
Description of Work
Const Type
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# Stories # Units (if Resf
Valuation $
Material/Labor -/ Qy�7
New/Add SFF_ Remodel SF Garage/New/Add
OWNER'S NAME Last First /" Z f
Owner's Address
Owner's E-mail Address
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City State F
Zip I Telephone
APPLICANT'S NAME Last . tL L
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Applicant's Address
Applicant's E-mail Address
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Zip L�l Telephone Il� E_3-c� -
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ARCHITECT/DESIGNER'S NAME Last , L First
��E,Lt � ( 5 l�Jl� Lic No.
ArchitectlDesigner's Address
Architect/Designers E-mail Address
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City C� �L u� �(� I State V
Zip �— Telephone
ENGINEER'S NAME Last I l—ex o j
First Lic. No.F
Engineer's Address
Engineer's E-mail Address
City State
Zip F Telephone 7r�
CONTRACTOR'S NAME/COMPANY r GC�L % U Lic No.� l lass
Contractor's Address
Co-nttrractor's E-mail Address
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City (j �, State I l Z
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Zip G/) Telephone
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SETBACKS REAR SETBACKS FRONT
PERMIT NO. x7 LI � 2-t;5
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $