HomeMy WebLinkAboutRev21-1796 - Permit ApplicationPrint Form 'i Worksheet for Combo Building & Solar Permit Application a�EW`°ae
Comm'I 7-$esidential City of Newport Beach - Building Division VO4 z!
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL u
'Building [Grading f -Drainage F-_Elec F_Mech F -Plum Cu yd Cut l Cu Yd Fill
Project Address (Not mailing address) r— Flood F_ Fire [ Liq r Landslide F_N/A Floor Suite No
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Description of Work Use Const Type I
[0C- ( Pie r�1 bids I��}T
h - - # Stories # Units (if Res)j-,
Valuation $
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New/Add SFF7 - - - Remodel SF�— Garage/New/Add � Material/Labor
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OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
- -- - ------ -
Clty �— State �— Zip [_—Telephones_
APPLICANT'S NAME
Last s- -_� � ------ First
Applicant's Address Applicant's E-mail Address
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City State �— Zip Telephone: Z f'S7
ARCHITECT/DESIGNER'S NAME
Last4 r7 ,t_�: First CX\- Lic. No. I
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Architect/Designer's Address Architect/Designer's E-mail Address
Cdy �- State �- Zip I Telephone
ENGINEER'S NAME Last �. First ��_ Lic. No
Engineer's Address Engineer's E-mail Address
-_-_------- - -
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City State s® Zip Telephoner
CONTRACTOR'S NAME/COMPANY r j� Lic. No. F_ 7 Classs
L yck a
Contractor's Address Contractor's E-mail Address
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City �— State �- zip Telephone
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SETBACKS REAR SETBACKS FRONT PERMIT NO,
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK N0.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $