HomeMy WebLinkAboutX2021-2968 - Permit Application (2)Print Form Worksheet for Combo Building & Solar Permit Application °F�`�'°Ra
City of Newport Beach - Building Division
r Comm'I Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL c
Building [Grading F-Drainage F_Elec F_Mech F-Plum cuvdCut cuvdFill _I
Project Address (Not mailing address) C Flood j- Fire F_ Liq F_ Landslide I -N/A Floor Suite No
Description of Work
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#Stories #Units (if Res)
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Valuation $
Material/Labor
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New/Add SFF Remodel SF Garage/New/Add
OWNER'S NAME Last f First
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Owner's Address Owners E-mail Address
City State �- Zip 7jUa(yZ Telephone S17_&34_-3D-S_F
APPLICANT'S NAME Last s� D First ► tr 4
Applicant's Address Applicant's E-mail Address
City State Zip - Telephoner
ARCHITECT/DESIGNER'S NAME Last First F Lic. No.
Architect/Designees Address ArchitecUDesigner's E-mail Address
City State F— Zip F TelephoneF—
ENGINEER'S NAME Last FirstF Lic. No.F—
Engineer's Address Engineer's E-mail Address
City State �— Zip I Telephone7—
CONTRACTOR'S NAME/COMPANY Lic. No. 7(o(f?J70)Class 3�
Contractor's Address Contractor's- ail Address
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City State Zip � Telephone�—
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SETBACKS REAR SETBACKS FRONT PERMIT NO. x%21 Lq�
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. Q �q ej - Z aZ
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $