HomeMy WebLinkAboutX2021-1706 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
r Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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)—Building F_ Grading
F Drainage r Elec r Mech (— Plum CuvdCut CuvdFill F
Project Address (Not mailing address) F_ Flood F_ Fire F_ Liq F_ Landslide rN/A Floor Suite No
) � i P\VevS ap
Description of Work
Use Const Type
# St ties \ # Units (if Res) ?X
Valuation
New/Add SFF_
Remodel SF F Garage/New/Add I
$
Material/Labor
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
State zip F Telephone
ARCHITECT/DESIGNER'S NAME Last First Lic. No. �-
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State F_— Zip F_ Telephoned
ENGINEER'S NAME
Last 1 Firs Lic. No.
6
Engineer's Address
Engineer's E-m it Addres�/��
Ci
State F Zip F TelephoneF
CONTRACTOR'SNAME/COMPANY ]U�US>'y �5"oth.�i((y\ CDh�f(,C) rjr LLL Lic. No. )(l0$ Qj Class
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Co orsAd
Contractor's E-mail Address
9110 E Ave-
sit _)8O
City nnj�'
State ( Zip gQ�(Z Telephone $62 • S2fr•
SETBACKS REAR
SETBACKS FRONT PERMIT NO. x(.vf.1�'101b
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. '
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $