HomeMy WebLinkAboutX2021-1675 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application &SWQ11F_ Comm'I F_Residential City of Newport Beach - Building Division n�NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Description of Work
Use F—Const Type F_
# StoriesF_ # Units (if Res)-
New/Add SF F—
Remodel SF qo 56 -4- Garage/New/Add �—
Valuation $ /J
Material/Labor :J 0
OWNER'S NAME
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Owner's Address
Owner's E-mail Address
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APPLICANT'S NAME
Last
First
Applicant's Address
Applicant's E-mail Address
City I—
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Zip [_ Telephoned
ARCHITECT/DESIGNER'S NAME Last �—
First F_ Lic. No. F_
Architect/Designer's Address
Architect/Designer's E-mail Address
City I—
State F_
Zip �— Telephoned
ENGINEER'S NAME
Last F—
First �— Lic. No.F_
Engineer's Address
Engineer's E-mail Address
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State �—
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CONTRACTOR'SNAME/COMPANY (%WA �L11��•-r�L Lic No. rj7107; Class
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Contractor's Address
Contractor's E-mail Address
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SETBACKS REAR
SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO,
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $