HomeMy WebLinkAboutX2021-0137 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application o4rEW�are
F- Comm'I F_ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAI
F`Building j- Grading f—Drainage F_ Elec F- Mech F- Plum Cu Yd Cut F_Cu Yd FiII F—
Project Address (Not mailing
address) 7 Flood F` Fire F— Liq F` Landslide I_N/A Floor Suite No
20(0(o2 /jEi✓Pblq?
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Description of Work
Use ConstType F_
# Stories[ # Units (if Res)[
Valuation $
Material/Labor
New/Add SF�� Remodel SFF—
Garage/New/Add F—
OWNER'S NAME Last F—
First
Owner's Address
Owner's E-mail Address
City �—
State
Zip F —. TelephoneF
APPLICANT'S NAME Last
F—
First
Applicant's Address
Applicant's E-mail Address
City F—
State �—
Zip F_ TelephoneF_
ARCHITECT/DESIGNER'S NAME
Last F_
First Lic. No. F_
Architect/Designer's Address
Architect/Designer's E-mail Address
City F—
State
Zip �� TelephoneF—
ENGINEER'S NAME Last
F—
� First F_ Lic. No.F_
Engineer's Address
Engineer's E-mail Address
City
State
Zip F TelephoneF—
CONTRACTOR'S NAME/COMPANY
�.
�eC1 Lic. No. �, ? 17 Class
Contractor's Address
Contractor's E-mail Address
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l . )1 jai l o
City �J'�w i):='G�
State /-t
Zip {� `�'.; ^ Telephone 7 ,I '-�_�(�,� ?v7
0-,
SETBACKS REAR
SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $