HomeMy WebLinkAboutX2021-2343 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit AgaLlcation
( Comm'] Residential City of Newport Beach - Building Division o
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITT
Building F_ Grading F-Drainage F_Elec F_Mech
F_ Plum CuYdCut CuYdFill F
Project Address (Not mailing address) F_ Flood
r Fire [_ Liq F_ Landslide F_N/A Floor Suite No
u/oo,�J 6✓L.
Description of Work I
Use F—Const Type
# Stories #Units (if Res)
Valuation $
Material/Labor '✓✓
New/Add SF chi Remodel SF F d Garage/New/Add
OWNER'S NAME Last First f, /
Owner's Address
Owner's E-mail Address
City /v yv State LSL
Zip � �( Jz Telephone ,5
APPLICANT'S NAME Last
First I 'k--
Applicant's Address
Applicant's E-mail Address
ST
rE 7 �� /yJon fir/ Fin/ ��✓LS C1
City /t/K- W 11_o,�Ll% f G/� State G�
Zip 9Z 6(oO Telephone .1 K�f �D 2 r3 Z 2,
ARCHITECT/DESIGNER'S NAME Last First Lic. No. F_
Architect/Designers Address
Architect/Designers E-mail Address
City State �—
Zip � Telephone
ENGINEER'S NAME Last P01,jV_a First ,C7/ Lic No. (7:71.�/�
Engineer's Address
Engineer's E-mail Address
City State
Zip � Telephoned
CONTRACTOR'S NAME/COMPANY
Lic. No. Class
Contractor's E-mail Address �y 1
Contractors Address
City State
Zip F__ Telephoned®
SETBACKS REAR SETBACKS FRONT
PERMIT NO. (�
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $