HomeMy WebLinkAboutX2021-1348 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
r Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) F_ Flood `s Fire F Liq r Landslide r_N/A Floor Suite No
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Valuation $
Material/Labor Za'QQO
New/Add SFr-iW Remodel SF �-�
Garage/New/Add Q %
OWNER'S NAME Last _� I t _
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First
Owner's Address
Owner's E-mail Address
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City G State I
Zip I Telephone ll '1!%*
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City � State F_
Zip Telephone r_
ARCHITECT/DESIGNER'S NAME Last
First i ro I f Lic. No.
Architect/Designer's Address
Architect/Designees E-mail Address
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City j _ _... 154�tate Ia
Zip Telephone 2• ��) Y.
ENGINEER'S NAME Last
First I ---- -- Lic. No.
Engineer's Address
Engineer's E-mail Address
City ', State I_'.
Zip IAV Telephone
CONTRACTOR'S NAME/COMPANY Lic. No. F---- Class
Contractor's Address
Contractor's E-mail Address
City _ State I--------.
Zip r-..--------_ Telephone)—
SETBACKS REAR SETBACKS FRONT
PERMIT NO. �V v
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. S�LdLJ
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $