HomeMy WebLinkAboutX2021-2006 - Permit Application1 Print Form - Worksheet for Combo Building & Solar Permit Application
r- Comm] F_ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F—Building F_Grading kDraina e rElec F_Mech
j—plum Cu vd Cut F_Cu Yd Fill
Project Address (No mcailing address) F_ Flood r Fire F_ Liq j— Landslide F_N/A Floor Suite No
Description of Work t� C
Use P' ConstType�
# Stories # Units (if Res)
Valuation
New/Add SF Remodel SF Ff C�� Garage/New/Add
U -- _ JI � _
$
Material/Labor
OWNER'S NAME Last
First
Owner's Address
Owner's E-mail Address
City State
- _
Zip Telephone j[ U 8-�L
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City State
Zip F Telephoner
ARCHITECT/DESIGNER'S NAME Last First Lic. No. r
Architect/Designer's Address
Architect/Designer's E-mail Address
1 2, C
City �` State �—
Zip Z Telephone L:7 _ .
I
ENGINEER'S NAME Last
First [� - Lic No.F—
Engineer's Address
Engineer's E-mail Address / ! _
City State F®
Zip I Telephone[ —
CONTRACTOR'S NAME/COMPANY
Lic. No. F— Class
Contractor's Address
Contractor's E-mail Address
City State F
Zip F_ Telephoned
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. l-T5
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $
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