HomeMy WebLinkAboutX2021-1429 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application o4rEW�,�
Cityof Newport Beach - Building Division
� Comm'I � Residential p 9 4
NOTE: PLAN CHECK FEES DIrF AT TIME nF cl rRnniTTai
[-"Building [-Grading [—Drainage [-Elec [-Meth [-Plum Cu Yd Cutr- Cu Yd Fill
Project Address (Not mailing address) [- Flood Fire [- Liq [- Landslide [-N/A Floor Suite No
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Description of Work
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Use % °ConstType
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# Stories # U )
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New/Add SF Remodel SF-— Garage/New/Add r
abor
OWNER'S NAME /`', '—
Last l � r__ First r
Owner's Addrpss
Owner's E-mail Address
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City 1 ., State `� ���. Zip Gib �� �' Telephone
APPLICANT'S NAME Last �;``�_`; rJ._ First :,
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Applicant's Address Applicant's E-mail Address
City I,�: State-+, Zip t ! Telephone i .l'�
ARCHITECT/DESIGNER'S NAME Last First F
Lic. No. F_
Architect/Designer's Address Architect/Designer's E-mail Address
City State I.----- Zip r—----�Teleph—onef——
ENGINEER'S NAME Last l �' First Lic.No.r
Engineer's Address Engineer's E-mail Address C, -. G lZ.r
City F_ State F_ Zip f —- Telephoned --
CONTRACTOR'S NAME/COMPANY Lit. No. F — Classf __
Contractor's Address Contractor's E-mail Address
City State �— Zip � Telephoned
SETBACKS REAR SETBACKS FRONT PERMIT NO. V'
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO!
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $