HomeMy WebLinkAboutX2021-2762 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
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j� Comm'I r Residential City of Newport Beach - Building Division �(��` -�J
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMI TAL ` v l!/ FOM1N
F-Building F_ Grading
F-Drainage j— Elec j` Mech
r- Plum Cu Yd Cut Cu Yd Fill
Project Addre (Not mailingad ) [ FI od
Fire j_ Liq Landslide F_N/A Floor Suite No
Description of Work
Use I— Const Type
# StoriesF_ # Units (if Res)-
Valuation $
Material/Labor
New/Add SF Remodel SF f Garage/New/Add F—
OWNER'S NAME
Last a\( First
Owner's Address
Owner's E-mail Address
City ��)) r�
State ��
Zi �� Tele hone E
PLICANT'S NAME
Last
First
Applicant's Address
Applicant's E-mail Address
City
State
Zip e Telephone
ARCHITECT/DESIGNER'S NAME Last
First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State F_
Zip Telephone
ENGINEER'S NAME
Last
First Lic. No.
Engineer's Address
Engineer's E-mail Address
City
State
Zip Telephone
NAME/COMPANY
Lic. No. F— ClassF
CONTRACTOR'S
Contractor's Address
Contractor's E-mail Address
City
State �—
Zip Telephone C}
2- I s/
FRONT
PERMIT NO. VU 4- q.t)Z-
SETBACKS REAR
SETBACKS
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $