HomeMy WebLinkAboutX2021-1414 - Permit Applicationprint Form Worksheet for Combo Building & Solar Permit Applicationna
F Comm'I F Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
(`Building r Grading (Drainage r Elec F Mech
F- Plum cuvdCut F_ cuvdFill
Project Address (Not mailing address) f Flood
F_ Fire j" Liq F- Landslide [_N/AFloor Suite No
J
/ qi '_ /ram
I r -_-.-- F__
Description of Work
Use ConstType��
# Stories[— # Units (if Res)_
j
f
aluation $ �Q(%}
Material/Cabo+ U�LJ
New/Add SF�---- Remodel SF Garage/New/Add
I----
OWNER'S NAME Last � v P � js'
First
Owner's Address
Owner's E-mail Address
City State F --
Zip TelephoneF_
APPLICANT'S NAME Last ! V� ��_
First /
Applicant's Address ? �—
Applicant's E-m 'Address
City F� State F Zip [— TelephoneF—
ARCHITECT/DESIGNER'S NAME Last F—
First F_
Lic. Na.
Architect/Designer's Address
F'
Architect/Designer's E-mail Address
City [� State �— Zip
I
�� Telephoned`
ENGINEER'S NAME Last 77 =
First' ' Lic. No. c If 1113
Engineer's Address
Engineer' -mail Address �
City State F�5— Zip
�?r"_/ TelephoneF—
CONTRACTOR'S NAME/COMPANY Q�11 � Lic No. ^ Class
Contractor's Address
Contractor's E-mail Address
City 7_�E; State Zip
,.G ^� Telephone
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $