HomeMy WebLinkAboutX2021-3184 - Permit Application (2)Worksheet for Combo Building & Solar Permit Application
Comm'I r Residential City of Newport Beach - Building Divisionoftel
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMXAaqmv *6 KI
-Building
F- - Grading F -Drainage Elec Mech Plum
F ..
Cu Yd Fill
Fire Landslide N/A Floor
.t Address (Not mailing address) F Flood F
F Liq Suite No
�qz
tion of Work
,�7 1 e�� Use F711 Const Type F
# StoriesF - # Units (if Res)F
-- I Valuation$
New/Add SFF— Remodel Garage/New/Add[_ 1Material/Labor
OWNER'S NAMELast First
Owner's Address Owner's E-mail Address
- - - -------
cityF�;
State -,PT zip qFZj5*Zi57
---- - ---- ---- i [6 - - ---- Telephon��y �W�/
APPLICANT'S NAME Last
First
Applicants Address Applicant's E-mail Address
City State Zip q
q5- Telephon
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
ArchitectIDesigners Address Architect/Designers E-mail Address
-- --- ----- --- ; --- ---- ,
City State Zip TeIephoneF--------
ENGINEER'S NAME Last First Lic. No.F
Engineer's Address Engineer's E-mail Address
- ------ ----- - ---- - 11 - I
Cityl-- - - ------------ State F- Zip Telephoner
CONTRACTOR'S NAME/COMPANY e Lic. No. Class
Contractor's Address Contractor's E-mail Address
City State zip Telephon
SETBACKS REAR
SETBACKS LEFT
USE ZONE
SETBACKS FRONT
SETBACKS RIGHT
DEVELOPMENT NO
PERMIT NO.
PLAN CHECK NO.
-CHECK FEES$