HomeMy WebLinkAboutX2021-2097 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit A lication EWER.
F Comm'I r Residential City of Newport Beach - Building Division X//�J�J�/,(jp��] (�
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL " " (/�/`� �� V
Buildin G"`°°"•"
g r Grading rDrainage r Elec r Mech Pluml I�
Cu Yd Cutl Cu Yd Fill
Project Address (Not mailing address) Flood F Firer Liq r Landslide [_N/A Floor Suite No
Description of Work y
Use Const Type F _
# Stories # Units (if Res)
New/Add SFF_ ---' Remodel SFr Garage/New/Add ^ Valuation $ p7
- �� Material/Labo ( 6
OWNER'S NAME Last
First
Owner's Address
-2j -7 14Lv4 Owner's E-mail Address
City Po State r 4�_
Telephonef�
APPLICANT'S NAME Last
T First
Applicant's Address - (C—
n Applicant's E-mail Address
City State
Zip 2�p`p?. Telephone R'' • r i (
ARCHITECT/DESIGNER'S NAME J
Last First
Architect/Designer's Address - Lic. No. r-------
Architect/Designer's E-mail Address
City
_.. ...State I � Zip F�.,. Telephone
ENGINEER'S NAME Last
First r---- Lic. No.r------
Engineer's Address
Engineer's E-mail Address
City
State I-_ Zip [� Telephoner------
CONTRACTOR'S NAME/COMPANY
Lic. No. r— -- Class
Contractor's Address
Contractor's E-mail Address
City State r ------
ZIP r-�_®—�_-�- Telephone)—�
SETBACKS REAR SETBACKS FRONT �4
PERMIT NO.
SETBACKS LEFT �—
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE �--
DEVELOPMENT NO PLAN CHECK FEES $ l