HomeMy WebLinkAboutS2021-0185 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application o�EW�Ra
iX Comm'I [X Residential City of Newport Beach - Building Division S7/D%/1 -
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
[XlBuilding FX_ Grading
rDrainage [Elec FX_ FX— Plum Cu Yd Cut F' Cu Yd Fill F_
Project Address (Not mailing address) [x,, Flood � Fire [X' Liq FX, Landslide rN/A Floor Suite No
Description o'f�Work
Use F_ Const Type F_
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t G 6�f� S� -
#Stories #Units (if Res)[
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Valuation$
Material/Labor
New/Add SFF— Remodel SF F_
Garage/New/Add
OWNERS NAME
Last ? en -
/�/ /—;
First
Owner's Address
Ow ner's E-mail Address
City ]eAc)
rStateZip
F1— Telephone C
APPLICANT'S NAME
Last
First
Applicant's Address
Applicant's E-mail Address
City
State F
Zip F— Telephoner
ARCHITECT/DESIGNER'S NAME Last
FirstF Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State
Zip �— Telephoner
ENGINEER'S NAME
Last
First Lic. No.1
Engineer's Address
Engineer's E-mail Address
City
j�
State
Zip Telephone
CONTRACTOR'S NAME/COMPANY
Lic. No. — ! Class
Contractor's Address
�jF
Contractor's E-mail Address
City
State F--
Zip � Telephone
SETBACKS REAR
SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO. 1 V
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES S