HomeMy WebLinkAboutX2021-2892 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application oc` aPo+'e
r Comm'I j Residential
City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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F-PlumCu Yd Cutl Cu Yd Fill
Project Address (Not mailing address) F_ Flood F- Fire j-" Liq 7- Landslide FN/A Floor Suite No
3 1
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Description of Work
Use ConstType
# Stories #Units (if Res)
New/Add SFF—
Remodel SFF— Garage/New/Add F
Valuation $
Material/Laborl
OWNER'S NAME
Last ���;
First -f �,,r:/�J
Owner's Address
Owner's E-mail Address
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City>>/
State
ZipTelephone (7�G'n/�
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APPLICANT'S NAME
Las
First
Applicant's Address
Applicant's E-mail Address
City
State F_
Zip F_ TelephoneF_
ARCHITECT/DESIGNER'S NAME Last �—
First Lic No.
Architect/Designer's Address
Its
Architect/Designer's E-mail Address
City
State �
Zip J TelephoneF_
ENGINEER'S NAME
Last
First F Lic.
Engineer's Address
;
Engineer's E-mail Address
City �--._'—
State ��
Zip F_ Telephoned
CONTRACTOR'S NAME/COMPANY '" i//�
;A rv° Lic No. �— Class
Contractor's Address h,,�-�//�� /� "
Contractor's E-mail Address
City �—
State F_
Zip Telephoned
SETBACKS REAR
SETBACKS FRONT
PERMIT NO. k, W - I ' //
SETBACKS LEFT
SETBACKS RIGHT
77
PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $