HomeMy WebLinkAboutX2021-0504 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application o�EW�Re
r Comm'I r Residential
City of Newport Beach - Building Division
z
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding rGrading r'Drainage rElec r'Mech
rPlum CuvdCut F cuvdFill F
Project Address (Not mailing
address) r Flood
r Fire r Liq rLandslide rN/A Floor Suite No
Description of Work
Use F ConstType I —I
# Stories # Units (if Res',
Valuation $
New/Add SFF_ Remodel SFF Garage/New/Add
F__
Material/Labor
OWNER'S NAME Last
First
Owners Address
Owner's E-mail Address
Ci
State 1
Zip F Telephone
"APPLICANT'S NAME Last
✓"` a
First `S /} V
Applicant's Address
14,4
Applicant's E-mail Address
City L S
L_-G.Nn
State C6}
zip %Z 6 Telephond
_ —
ARCHITECT/DESIGNER'S-tNNAME
Last First F —
Lic. No.
Architect/Designer's Address
I
I
Architect/Designer's E-mail Address -
City
State F777
Zip F Telephoned'
ENGINEER'S NAME Last
r
First F ! Lic NoT
Engineers Address
Engineer's E-mail Address
Ci
State F—
Zip I Telephoned
C TRACTOR' NAME/COMPANY
p Lic. No. \a? 6 746 Class
`^r
^
Contr tor' Address
Contractor's E-mail Address
'2CiNA,,�aL_
State A
Zip Telephone
4 ? _Z 3 3 56
e
SET REAR
SETBACKS FRONT
PERMIT NO. X ZoZ l _ O S6H
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO. Q y b 5 Z OZ\
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $