HomeMy WebLinkAboutX2021-1639 - Permit ApplicationPrint Form Worksheet for Combo Building &Solar Permit Applicationsea
F_ Comm'I F Residential City of Newport Beach -Building Division o i� NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
j—Building F_Grading
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j"Drainage rElec rMech r --Plum CuvdCut r cuvdFill
Project Address (Not mailing address) F Flood ( Fire F_ Liq f— Landslide rN/A Floor Suite No
Description of Work
Use F_ Const Type F_
# Stories # Units (if Res)F
Valuation $
Material/Labor
New/AddSFF - -
Remodel SFF------ Garage/New/Add ---
OWNER'S NAME
Last First
Owner's Address
Owners E-mail Address
City _..
_. ...State (-_.. Zip [---- Telephone[.-----
APPLICANT'S NAME
Last First
Applicant's Address
Applicant's E-mail Address -
City r-----
State (----- Zip �— Telephoner
ARCHITECT/DESIGNER'S NAME Last First F_ Lit. No. r—
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State r Zip [ Telephoner---- ,
ENGINEER'S NAME
Last s � — First F Lic No.F---
Engineer's Address
Engineer's E-mail Address
City
State r Zip r— Telephoner
CONTRACTOR'S NAME/COMPANY (�Y t%�(,t (" o '/ ,� Lic. No: �d F� Class
c, c� J
Contractor's Address Contractor's E-mailAddress
a2d� F - Cd(bm d S f
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City FA 4q 'e.; i-% State 1 C7T Zip 7226cy( Telephone %IY� L ( 3yo
SETBACKS REAR
SETBACKS FRONT PERMITNO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. E Z ZOtA
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $
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