HomeMy WebLinkAboutX2021-2423 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application°jjjaa
F_ Corl r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
("Building F_Grading F-Drainage rElec rMech
Plum Cu Yd cuts Cu Yd Fills
Project Address (Not mailing address) F_ Flood r Fire r" Liq F_ Landslide FN/A Floor Suite No
Description of Work
Use F—Const Type
# Storiess # Units (if Res)[ —
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Valuation $ ; n
Material/Labor C�
New/Add SFF— Remodel SF �— Garage/New/Add F
OWNER'S NAME Last 07���`"I !Z
First U L�
Owner's Addres/s�
Owner's E-mail Address'.
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City � W a � � t' PLC ( State v `
Zip ? � ZS/ Telephone — q u -- 61 "7 )
APPLICANT'S NAME Last J j fj 5
d
First
Applicant's Address
Applicant's E-mail Address
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City /�� A State l
Zip 1 Telephone U I t — �?
ARCHITECT/DESIGNER'S NAME Last a A
First t� V Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Ad11dress
City I State F_
Zip F_ Telephones
ENGINEER'S NAME Last rbKbS5
First ,��Q�� Lic No. j --7
Engineer's Address
Engineer's E-mail Address
City State
Zip F Telephone F_
CONTRACTOR'S NAME/COMPANY the P,tel,nl boo Lic. No. I066 j 37 Class
!Contractor's
Contractor's Address _
E-mail Address
i3sv �yhald; A �l17
City I r J IrV I State
Zip �Z(r l LI Telephone
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. L
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $