HomeMy WebLinkAboutX2021-3375 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application °2SW°°qm
r Comm'I (- Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Xuildin Grading Draina a Elec Mech yd ct`
9 r r r Plum Cu Vd Fill F
�d
(9
Project Address Not mailingaddress f Flood Fire Li '
r Lan �/A
, q� 'rr�� Floor Suite No
22Z 1� L- L► r, T,T C1s�l
/
Description of Work :
'
Const Type I `f j�
# Stories #Units (if Res)
r
Valuation $
Material/Labor + � �
New/Add SF �� Remodel SF�— Garage/New/Add F
OWNER'S NAME Last SDrf-, FirstFF
Owner's Address Owner's E-mail Address
City State F Zip F— Telephone[7777777777
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
L''.c-' •„ y s Imo. 2.> J •� 1=�� 1 ��J�ifji. •�.i-1J �l _�-�4� � d"�'4 1 � � n
City State Zip Telephone
ARCHITECT/DESIGNER'S NAME Last First �_ �,RI^ 1 �- � Lic. No. M--
Architect/De}}ss�ig��nees Address Architect/Designer's E-mail Address
rD
—
City fit ti/ JCL lt�� State C Zip U �bJJ .-. Telephone
ENGINEER'S NAME Last First F_ Lic. No.1
Engineer's Address Engineer's E-mail Address
City State �— Zip 7— TelephoneF—
CONTRACTOR'S NAME/COMPANY Lic NoT — ClassF
Contractor's Address •'� Contractor's E-mail Address
City State F— Zip I Telephoned!
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $