HomeMy WebLinkAboutX2021-3451 - Permit Application (4)Worksheet for Combo Building
& Solar Permit Application
'50 04
City of Newport Beach - Building Division
f— Comm'[ F Residential
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Cu Yd Cut Cu Yd Fill F
Project Address (Not mailing address) f_-: Flood 17, Fire f7, Liq [7 Landslide f_�N/A Floor Suite No
Description of Work Use F Const Type F77
Valuation $
OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
State
city zip F TelephoneF
APPLICANT'S NAME Last
Applicant's Address Applicant's E-mail Address
City |S�u�o | Zip Telephone |
ARCHITECT/DESIGNER'S N8ME
Luot| |FintF | LicNo.|
Architect/Designer's Architect/Designees E-mail Address
City | �8�oLo Zip | Telephone !
ENGINEER'S NAME Last First Lic. No.
Engineer's Address Engineer's E-mail Address -
City State Zip| | Telephone| |
CO0TR&CTOR'SN&K8BXOMP&NY LicNo. class[
Contractor's Address a Contractor's E-mail Address
UO
City |0�a�a |Zip|c��'����J! Telephone ^l
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $