HomeMy WebLinkAboutX2021-3375 - Permit Application (2)Print Form Worksheet for Combo Building & Solar Permit Application
Comm'I C Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
j- Grading [Drainage r Elec Mech Plum j�'
Cu Yd Cut
l
Address (Not mailing address) E Flood r Fire [ Liq [ Landslid
of Work
New/Add SF[�- Remodel
OWNER'S NAME Last
e
i Cu Yd Fill I—J
rN/A Floor Suite No
Use 177 ConstType C
# StoriesC, # Units (if Res)C
Valuation $
Garage/New/Add �— Material/Labor
- (�07
First
Owner's Address
Owner's E-mail Address
City C 1i State
Zip , h Te
APPLICANT'S NAME
Applicant's Address
City
ARCHITECT/DESIGNER'S NAME
First
Applicant's E-mail Address
State Zip Telephoned
Last First Lic. No.
Architect/Designer's Address Architect/Designees E-mail Address
cityI State L p �—' Telephone
Zi
ENGINEER'S NAME Last I First
Engineers Address Engineer's E-mail Address
City State �— Zip �— Telephoner
---- `
CONTRACTOR'S NAME/COMPANY
Contractors Address
City L— State �—
SETBACKS REAR
SETBACKS LEFT
USE ZONE
SETBACKS FRONT
SETBACKS RIGHT
DEVELOPMENT NO
No.
Lic. No.
Contractor's E-mail Address
Zip T 1 onh e�—
n ' IV1L
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEES $
Use 177 ConstType C
# StoriesC, # Units (if Res)C
Valuation $
Garage/New/Add �— Material/Labor
- (�07
First
Owner's Address
Owner's E-mail Address
City C 1i State
Zip , h Te
APPLICANT'S NAME
Applicant's Address
City
ARCHITECT/DESIGNER'S NAME
First
Applicant's E-mail Address
State Zip Telephoned
Last First Lic. No.
Architect/Designer's Address Architect/Designees E-mail Address
cityI State L p �—' Telephone
Zi
ENGINEER'S NAME Last I First
Engineers Address Engineer's E-mail Address
City State �— Zip �— Telephoner
---- `
CONTRACTOR'S NAME/COMPANY
Contractors Address
City L— State �—
SETBACKS REAR
SETBACKS LEFT
USE ZONE
SETBACKS FRONT
SETBACKS RIGHT
DEVELOPMENT NO
No.
Lic. No.
Contractor's E-mail Address
Zip T 1 onh e�—
n ' IV1L
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEES $