HomeMy WebLinkAboutX2021-3158 - Permit ApplicationJ_ _ Print Form j Worksheet for Combo Building & Solar Permit Application 11'E Q'>
r comm" Residential City of Newport Beach - Building Division
11 NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
V,@uilding [Grading
F-Drainage F_Elec F_Mech FPlum Cu vd Cut F_Cu Yd Fill F_
Project Address mailing address) F_ Flood F- Fire F- Liq r Landslide f N/A Floor Suite No
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Description of Work
Use F Const Type
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(I I ( h 1/t- VItlaI ✓t i 1AJo (
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lA ulh
;Stories #Units (if Res)
Valuation $
Material/Labor
New/AddSFI
Remodel SF Garage/New/Add
OWNER'S NAME
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Last lU� First y�
Owners Address
Owner's E-mail Address
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City
State Zip Telephone�—
APPLICANT'S NAME
Last` First 1+ I
Applicant's Address
Applicant's E-mail Address
City
State Zip Telephone 0[6JJ0,33,4qLi(
ARCHITECT/DESIGNER'S NAME Last -7-619 e sk" r
v First Lic. No. �OS�
Architect/Designer's Address
( Architect/Designer's E-mail Address
City
State F_— Zip F— Telephoned
ENGINEER'S NAME
Last F First F Lic No.F
Engineer's Address
Engineer's E-mail Address
City
State �® Zip � Telephone —
CONTRACTOR'S NAME/COMPANY Lic. No. F Class
Contractor's Address
Contractor's E-mail Address
City
State �- Zip F_ Telephoned!
SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. [ t 3O Z-OLA
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $