HomeMy WebLinkAboutX2021-2920 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
F_ Comm'I F_ Residential City of Newport Beach - Building Division x22100 A,16h *W
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
I[Building F_ Grading f—Drainage F7 Elec (—Meth F— Plum Cu yd cut
F Cu Yd Fill
Project Address (Not M21111ing address) F_ Flood F_- Fire F- -, Landslide [N/A � Liq F_ Floor Suite No
a (LIN,
Description of Work Use iConst Type 177
# Stories F__ # Units (if Res) —
Valuation $
New/Add SFF77777 Remodel SF I ----------- - - Garage/New/AddF— Material/Labor
OWNER'S NAME Last
Owner's Address
First
Owners E-mail Address
-- - ---- ------------- - IK,
City I---- - - State zip F_. Telephond Q4q
APPLICANT'S NAME Last 1 PAPA;
Applicant's Address
City State
First I
Applicant's E-mail Address
P5 MCIL
Zip Telephone
ARCHITECT/DESIGNER'S NAME Last First Lic. No. --
Architect/Designees Address
....... ....
city 5e -V Y%(L' State I C*
Architect/Designer's E-mail Address
- - ------- - -
Zip TelephoneE4
ENGINEER'S NAME Last First F Lic. No.F__
Engineer's Address
- - ------ ----- — - ------
city [ State F_
CONTRACTOR'S NAME/COMPANY
Engineer's E-mail Address
ZIP Telephone
Lic. No. Class
Contractor's Address Contractors E-mail Address
City State zip Telephonei_
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
PERMIT NO. 2�61 U
PLAN CHECK NO. 2_,& v\
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $