HomeMy WebLinkAboutF2021-0369 - Permit Application"arini Form ' Worksheet for Combo Building & Solar Permit Application
F-, Comm'I F Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
[Building (- Grading
Address
of Work
New/Add SFF____
r—Drainage [ Elec
mailing
F Mech Plum Cu Yd Cut Cu Yd Fill
rJ Flood r Fire r Liq (7 Landslide F7N/A Floor Suite No
F_ 77
Use F— ConstType
# StoriesF_ # Units (if Res)[7
Valuation $
RemodelSFF Garage/New/Add Material/La
OWNER'S NAME Last
Owner's Address
City State F_
APPLICANT'S NAME Last
Applicant's Address
City _ _ State
First
Owner's E-mail Address
Zip �—
First
Applicant's E-mail Address
Zip F_ Telephone
�—
ARCH ITECT/DESIGNER'S NAME Last First
Lic. No. �—
Architect/Designers Address
City State �—
Architect/Designer's E-mail Address
Zip TelephoneF—
ENGINEER'S NAME Last First Lic. No.F—
Engineer's Address
_.__ -- —
City State �—
Engineer's E-mail Address
Zip TelephoneF_
CONTRACTOR'S NAME/COMPANY ° Lic. No. SC j ��' Class
L"ai v Lam,. —
Contractor's Address
City — I V Y ` State C\
Contractor's E-mail Address
Zip Telephone Ct r --2Sy I{E
SETBACKS REAR SETBACKS FRONT PERMIT N0.N72 Cr i ( GI
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES S