HomeMy WebLinkAboutX2021-0136 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application o E
r Comm'I F- Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIM
E OF SUBMITTAL 5�„0,„.
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Elec �" Mech j``
`Building F— Grading F—Drainage F_Plum Cu Yd curCu Yd Filll
j—1
Project Address (Not mailing
address) f— Flood r Fire r Liq F Landslide F-N/A Floor
�l(o hir
Suite No
fF_
Description of Work
Use ConstType F
# St 8 Units (if Res)[—
Valuation
Material/Laho
New/Add SFF— Remodel
SFF— Garag a/New/Add �—
1!!
OWNER'S NAME Last
First
Owner's Address
Owner's E-mail Address
City �i
State r-- --
ZIP [_ Telephoned
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City
State F— Zip �— Telephone��
ARCHITECT/DESIGNER'S NAME
Last �— First �—Lic. F_
Architect/Designer's Address
No.
Architect/Designer's E-mail Address
City [�
State F_ Zip [_ TelephoneF_
ENGINEER'S NAME Last
F�
First F_
r
Lic. No.�
Engineer's Address
Engineer's E-mail Address
City [—
State Zip �` Telephoner
CONTRACTOR'S NAME/COMPANY
vJ .�u }1G . Lic. No. 4 j l qui Class
Contractor's Address
Contractor's E-mail Address
cl�f;s���N�@
City iVc,--.G.rj
State T
C r1 Zip 9LGG Z Telephone
S AC S REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
�"%�
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $