HomeMy WebLinkAboutX2021-3439 - Permit ApplicationPrint Form_ Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division
F- Comn l gResidential NOTE. PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
r Cud Fill �
j�uilding
Project
F_ Grading F—Drainage IKElec �Mech Plum CuvdCut
u
Address (Not mailing address) F_ Flood F_ Fire F— Liq F_ Landslide
Remodel SF t 4 , Garage/New/Add
F_N/A Floor
Suite No
Use ConstType�
# StoriesFT # Units (if Res)
I
Va terialn $ � � a
V� Material/Labor 7
OWNER'S NAME Last { First)
Owner's Address Owner's E-mail Address
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City ��p e,- State �e Zip -Z.,y Telephone �rL��GJ8 4C t`)
APPLICANT'S NAME Last
Applicant's Address \ G
City i .i l� I Cy Q State �G Zi{
First I 't "—
,pplicant's E-mail Wddress
Telephone qq
ARCHITECT SIGNER'S NAME Last �aN „ l,.e y Lic. No.
Architect/Designer's Address ' AKrch_itectIDesigner's E-mail Address
City State �— Zip �— TelephoneF—
ENGINEER'S NAME Last N First AV-44 Lic No.L��
Engineer's Address Engineer's E-mail Address
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City State I Gifu Zip O Z' Telephone
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CONTRACTOR'S NAME/COMPANY Lic. No. "37q?Class
Contractor's Address Contra toes E-mail Address s �`
I 2 IILf�� Gi_�{JCE'i c`y
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City J State I o— Zip. Telephone %� >
SETBACKS REAR
SETBACKS LEFT
USE ZONE
SETBACKS FRONT
SETBACKS RIGHT
DEVELOPMENT NO
PERMIT NO.
PLAN CHECK NO. �t? I J 1'i ✓I
PLAN CHECK FEES $