HomeMy WebLinkAboutS2021-0185 - Permit Application (2)Print Form j Worksheet for Combo Building & Solar Permit Application ozEW�"a
City of Newport Beach - Building Division
Comm'I FX— Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
r,Building FX_ Grading
[(,Drainage [,Elec [RMech (x, Plum Cu yd Cut FCuvdFill v
Project Address (Not mailing address) FF Flood F>_� Fire r Liq r, Landslide FX_N/A Floor Suite No
Description of Work�
Use � Const Type r
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# StoriesF_ # Units (if Res)[—
es)[—Valuation$
Valuation $
Material/Labor l 4,1
New/Add SFF —� Remodel SFF --
Garage/New/Add —!,
OWNER'S NAME
Last l U?"t°,n
a
First
Owner's Address
Owner's E-mail Address
14a � 4/
City % 60 2
7
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� dal-ITState p � Telephone Cq Q
APPLICANT'S NAME
Last
First
Applicant's Address
Applicant's E-mail Address
City
State
Zip F Telephone
ARCHITECT/DESIGNER'S NAME Last
First Lic. No.
Architect/Designees Address
Architect/Designer's E-mail Address
City
State
Zip— Telephoner
ENGINEER'S NAME
Last F
First _ Lic. No f —
Engineer's Address
Engineer's E-mail Address
City
State
--
Zip r- Telephoner
CONTRACTOR'S NAME/COMPANY
Lic. No. Classy—
Contractor's Address
Contractor's E-mail Address o V' ✓ t o
City
State �_
Zip F_ Telephone
SETBACKS REAR
SETBACKS FRONT
PERMIT N0. 16
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO. j -
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $