HomeMy WebLinkAboutPV2021-261 - Permit Application (2)pant Foir, . Worksheet for Combo Building & Solar Permit` Application
n Comm'I r7 Residential City of Newport Beach -Building Division wn21 . Z41 a
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL oea s
;Building ❑Grading rDrainage ❑Elec [-Wech Plum cuvdcut� cuvdFill
Project Address (Not mailing address) ❑ Flood F] Fire (j Liq [ Landslide ❑N/A Floor Suite No
Description of Work Use n Const Type F77
# Stories # Units (if Res)s1
Valuation $
New/Add SFJ Remodel SFF-1, Garage/New/Add F-1 Material/Labor �fb�
OWNER'S NAME Last I First I
Owner's Address Owner's E-mail Address
City State j Zip Telephone
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
City ( State Zip Telephoned
ARCHITECT/DESIGNER'S NAME Last First� Lic. No. J
ArchitecUDesigner's Address ArchitecVDesigner's E-mail Address
City — - I State I I Zip 1-7-1 Telephoned
----- - -----
ENGINEER'S NAME Last First i Lic. No.
Engineer's Address
Engineer's E-mail Address
I
-- ---- ----
-- - -
-
State FII
Zip
F77-7 Telephoned
-
J
City
CONTRACTOR'S NAME/COMPANY � v Lic. No. FISOUT Class
Contractor's Address Contractor's E-mail Address
City State I Zip Ji Telephoned
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
PERMIT NO.
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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