HomeMy WebLinkAboutX2021-3283 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division '
Comm'I F_ Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL J
uilding 7 Grading [—Drainage �L Elec r Mech F- Plum cuvdCut F_ cuvdFill [_
Project Address (Not mailing address) F Flood F_ Fire F Liq r Landslide r`N/A Floor Suite No
Description of Work
Use IT; ConstType
\
# Stories? # Units (if Res)
\ y
Valuation $
Material/Labor i c LJ
New/Add SF Remodel SF �� Garage/New/Add ��
OWNER'S NAME Last
First
Owner's Address
Owner's E-mail Address
City �— State F
Zip F_ Telephoner —
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City W`7 State ��
Zipa-- Telephone�—
ARCHITECT/DESIGNER'S NAME Last ( -----
First I Lic. No. F
Architect/Designer's Address --
Architect/Designer's E-mail Address
G�VN� Gi5 a, �n�k G
City �— � State �—
Zip �` Telephoned`
ENGINEER'S NAME Last �
First F_ Lic. No.F—
Engineer's Address
Engineer's E-mail Address
City F— State �—
Zip � Telephone��
CONTRACTOR'S NAME/COMPANY F
Lic. No. ti7_3L1 Z' Class
Contractor's Address
Contractor's E-mail Address
City I __.. State �
Zip F_ Telephoned
SETBACKS REAR SETBACKS FRONT
PERMIT NO. f - 320j
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $
M