HomeMy WebLinkAboutX2021-3242 - Permit ApplicationPrint Form J Worksheet for Combo Building & Solar Permit Application u=
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City of Newport Beach - Building Division Comm'I � Residential 9
NOTE: PLAN CHECK FEES DUE AT TIME nF al ianni -Tai
F-Building Grading F-Drainage F_Elec F_Mech FPlum Cu Yd Cut Cu Yd Fill F_
Project Address (Not mailing address) C Flood
r Firer Liq F_ Landslide I —N/A Floor Suite No
Description of Work
Use ConstType F
# StoriesF # Units (if Res)
Valuation $
Material/Labor
New/Add SF�— Remodel SF�
Garage/New/Add �—
OWNER'S NAME Last -r— I h in First
C f r
Owner's Address
Owner's E-mail Address
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City (lG+c7eort IY-,^ State Zip Telephone_L,il
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APPLICANT'S NAME Last & L)-ek5
First cam-{-
Applicant's Address
Applicant's E-mail Address
I.'vL't
City r t c Y ) A State
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Zip 9 ZS Oaj Tele hone
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ARCHITECT/DESIGNER'S NAME Last First F Lic. No. �—
Architect/Designer's Address
Architect/Designees E-mail Address
City State �—
Zip �— Telephone�—
ENGINEER'S NAME Last
First F Lic No.�
Engineer's Address
Engineer's E-mail Address
City State F_
Zip F— Telephone�—
CONTRACTOR'S NAME/COMPANY
Lic. No. �— ClassF_
Contractor's Address
Contractor's E-mail Address
city State �—
ZipF TelephoneF�
SETBACKS REAR SETBACKS FRONT
PERMIT NO. X2021 �Pfzi
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. ey "7
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $