HomeMy WebLinkAboutX2021-3076 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application cs�,P-D-,
City of Newport Beach - Building Division 0 a` 3�h r ComMll . (` Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL �°�
F—Building Grading
sDrainage r Elec F_ Mech
F— Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) F_ Flood
j— Fire r Liq F_ Landslide J_N/A Floor Suite No
3`�Z3
Description of Work
Use Const Type F
# Stories # Units (if Resf
iq loe?q I d c` Wa �
Valuation $
New/Add SF ��
Remodel SF Garage/New/Add
Material/Labor
OWNER'S NAME
Last 1tlU 2_ First F g f:e
Owner's Address
Owner's E-mail Address
City
State F
Zip s—s Telephone
APPLICANT'S NAME
Last
First k,; S
Applicant's Address
Applicant's E-mail Address
City
State F
Zip Telephone
ARCHITECT/DESIGNER'S NAME Last
First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State
Zip--� Telephone
ENGINEER'S NAME
Last F_
First _ _ - Lic. No.
Engineer's Address
Engineer's E-mail Address
City F�
State F_
Zip Telephone
Lic. No. F106 gej?o Class
CONTRACTOR'S NAME/COMPANY
�' p S
G
'S
Contractor's Address
Contractor's E-mail Address
1
7____�
City
State F
11 - 11 1 1 - I
Zip F Telephone
SETBACKS REAR
SETBACKS FRONT
PERMIT NO. 2d 2-3(J
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $