HomeMy WebLinkAboutX2021-1818 - Permit ApplicationI!
erint Form Worksheet for Combo Building & Solar Permit ica ohl
/ Comm'I [ Residential City of Newport Beach - Building Division o L
A— NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
r— Building (—Grading F—Drainage F_Elec Mech Plum cuvdCut l Cu Yd Fill
ProjectAddress (Not mailing address) Floo�d� F_ Fire F Liq r— Landslide CN/A Floor Suite No
/C `
11
Description of Work
Use F Const Type F
M
# Stories # Units (if Res)F
Valuation $
New/Add SFF— Remodel SFF— Garage/New/Add F-1Material/Labor
OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
City State 7 Zip F Telephone f -----
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
City _. State F_ Zip [_ Telephoner--
ARCHITECT/DESIGNER'S NAME Last _.. '. First F_. Lic. No. �--------
Architect/Designees Address Architect/Designer's E-mail Address
City State F Zip F_ Telephoner— --
ENGINEER'S NAME Last First I Lic No.w
Engineer's Address Engineer's E-mail Address
City State F_ Zip F_ Telephoner
CONTRACTOR'S NAME/COMPANY Lic. No. F— Class'
Contractor's Address Contractor's E-mail Address
City State F-- zipr— Telephoner
SETBACKS REAR /S SETBACKS FRONT I Q PERMIT NO.
SETBACKS LEFT �j SETBACKS RIGHT PLAN CHECK NO.
1
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $