HomeMy WebLinkAboutX2021-2362 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
j- Comm'I (a6 Residential City of Newport Beach - Building Division X20=1-26102
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Building r Grading Drainage rElec (—Mech F== Plum CuvdCut Cu rd Fill F v
Project Address (Not mailing address) C Flood r Fire F_ Liq r Landslide F_N/A Floor Suite No
Description of Work
Use Const Type
#Stories #Units (if Res)
Valuation $ 1
Material/Labor
New/Add SIF Remodel SF �— Garage/New/Add
OWNER'S NAME Lastly(, First
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Owner's Address Owner's E-mail Address
City P:,e State C4 Zip (3 (a Telephone[—
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
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city State Zip Telephone q . 58� P
ARCHITECT/DESIGNER'S NAME Last First F Lic. No. F—
Architect/Designer's Address Architect/Designees E-mail Address
City State F Zip F Telephone
ENGINEER'S NAME Last First Lic. No.
Engineer's Address Engineer's E-mail Address
City State Zip I Telephoned
CONTRACTOR'S NAME/COMPANY Lic. Na.
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Contractor's Address Contractor's E-mail Address
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City �Qtfrh(v____ State �— Zip .. qze oij Telephone
SETBACKS REAR SETBACKS FRONT PERMIT N0. X2aZ Z(7�
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. 70y7 - e�e)Z,
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $