HomeMy WebLinkAboutX2021-0061 - Permit Application_ '' Worksheet for Combo Building & Solar Permit Application Print Form °"^
F- Comm'I j— Residential City of Newport Beach - Building Division o s
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
(—Building F_ Grading F-Drainage ' lec ech
Plum Cu Yd Cut Cu Yd Fill F
Project Address (Not mailing
a dress) Flood
�F_` Fire Liq Landslide 1—N/A Floor Suite No
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Description of Work
Us Const Type
# Storie # Units (if Res)
Valuation $
Material/Labor
New/Add SFF Remodel SF Garage/New/Add
OWNER'S NAME Last
First
Owner's Address
Owner's E-mail Address
City
State F
Zip Telephoned
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City
State
Zip TelephoneF
ARCHITECT/DESIGNER'S NAME
Last First Lic. No.
Architect/Designees Address
Architect/Designer's E-mail Address
City
State �-
Zip F Telephoner
ENGINEER'S NAME Last
First ��� Lic.f��"'' 1
i
Engineer's Address
Engineers E-ma I Address
City
State F_
Zip F_ Telephone
CONTRACTOR'S NAME/COMPANY
J Lic No. `� o f Z �' Class j 3
�y3., Y6 �
Contractor's Address
ConCractor's E-mail Address
cc L
City � 'psi L.;n �.
State � �
Zip Tele �
P 12Jd C' Phone
SETBACKS REAR
SETBACKS FRONT
PERMIT NO. xa 62 1 - 00 o
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO
_ PLAN CHECK FEES $ ;