HomeMy WebLinkAboutX2021-3281 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
r Comm'I ' j Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
j Building jGrading �,Orainage jElec r"iMech rPlum Cu yd cut Cu Yd Fill
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Project Address (Not mailing address) r Flood C Fire C Liq, G Landslide CN/A Floor Suite No
Description of Work Use Const Type
# StoriesC # Units (if Res[7
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aluation $
New/Add'SF... Remotlel'SFi� Garage/New/Add Material/Labor Y/ ;
kOWNER'SINAME I Last, First
Owner' ,Address Owner's E-mail Address '
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r City State Zip —G TelephoneL_
APPLICANT'S NAME Last , First
i Applicants --Address. Applicant's E-mail Address
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I � ' I
City, State � Zip Telepfione
ARCHITECT/DESIGNER'S NAME Last F First
Lic. No. �f r � — 1
Architect/Designer's Address Architect/Designees E-mail Address
City I State L i Zip �1 Telephoned
I
ENGINEER'S NAME Last _ I First �— Lic Nol
Engineer's Address Engineer's E-mail Address
City. State �— Zip I i Telephoned
CONTRACTOR'S NAME/COMPANY Llc. No. l Class
Contractor'siAdtlress Contractor's E-mail Address
City —7 State _- Zip Y Telepoo: F ✓�6
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SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO, 'jQj •�yj
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $