HomeMy WebLinkAboutX2021-0110 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application E° °R
City of Newport Beach - Building Division
j- Comm'I r Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding r Grading
rDrainage r Elec r Mech r Plum CuvdCut l CuYdFill
Project Address (Not mailing address) F_ Flood F= Fire j" Liq F_ Landslide F_N/A Floor Suite No
at S l-�C&S�
F_
Description of Work
Use F—ConstType �—
�
# Stories[— # Units (if Res)[_
Valuation $
Material/Labor
New/Add SFf — �-- Remodel SF F— Garage/New/Add F—
OWNER'S NAME
Last
First
Owner's Address
Owner's E-mail Address
City
State �—
Zip F_ Telephoned
APPLICANT'S NAME
Last
First
Applicant's Address
Applicant's E-mail Address
City F_
State F
zip lF--- Telephoner—
ARCHITECT/DESIGNER'S NAME Last F First F_ Lic. No. I--_
Architect/Designer's Address
Architect/Designer's E-mail Address
City I
State �i
Zip Telephoned
ENGINEER'S NAME
Last F
First F_ Lic. No.F—
Engineer's Address
Engineer's E-mail Address
City
State F_
Zip F--- Telephoned
CONTRACTOR'S NAME/COMPANY
� u( I� ti
`"'��
�� S �C�� Lic. No. i93 71os Class
Contractor's Address
Contractor's E-mail Address
301 1)02Ar(
ST-
City V) C; T4
State C/
Zip 1 Z,0 3 Telephone 9gCI. 10
SETBACKS REAR
SETBACKS FRONT
PERMIT NO. M,01A, O\ko
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK N0. \� _ --Z71I
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $