HomeMy WebLinkAboutM2021-0082 - Permit Applicationrant l-orm
worKsneet for Combo Building & Solar Permit Application
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f Residential City of Newport Beach -Building Division
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NOTE: PLAN CHECK FEES DUE ATTIME OF SUBMITTAL
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Cu Yd Fill
Project Address (Not mailing address) I— Flood r Fire r- Liq j— Landslide
I —N/A Floor
Suite No
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New/Add SFI— Remodel SFF Garage/New/Add �—
OWNER'S NAME Last
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Use l ConstType l
# StoriesF_ , # CCr if3 (if Res)F—
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Owner's Address Owner's E-mail Address
City State �— Zip F Telephone) --
APPLICANT'S NAME Last JTZr First j jrjJ
Applicant's Address Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last �—
Architect/Designer's Address
City State
ENGINEER'S NAME
Engineer's Address
City
Last
State
First I Lic. No. �—
ArchitecUDesigner's E-mail Address
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ZIP F— Telephone u -
First) Lic. No.
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Engineer's E-mail Address
ZIP �— Telephone�—
CONTRACTOR'S NAME/COMPANY �Ju,�T�� / ic. N ��6 /% Class
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Contractor's Address Contractor's E-mail Address
City %fp s /,?4 y State Zlp �Telephone ;v� 77Z -? 70
SETBACKS REAR SETBACKS FRONT PERMIT NO. l) v Z
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK 1\10.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
Print Form J 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
F-Building F-Grading F—Drainage F-Elec FMech r Plum CuYdCut s CuYdFill
F
Project Address (Not mailing address) F- Flood F Fire r Liq F- Landslide F_N/A Floor Suite No
Description of Work
Use s Const Type
# Stories # Units (if Res)s
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SC .� telC
Valuation $
Material/Labor
New/AddSFs— Remodel SFF— Garage/New/Add
OWNER'S NAME Last C/4 / First
Owner's Address Owner's E-mail Address
City State �— Zip � Telephones—
APPLICANT'S NAME Last S'.d First
Applicant's Address Applicant's E-mail Address
City ,;14 lwfej, State Zip �Z`�L Telephone 7/cj 7S�j, /dl�O
ARCHITECT/DESIGNER'S NAME Last First Lic. No. �—
Architect/Designer's Address Architect/Designer's E-mail Address
City I State F_— Zip F Telephone[
ENGINEER'S NAME Last First Lic. No.
Engineers Address Engineers E-mail Address
City State F— Zip � Telephone[ ---
CONTRACTORS NAME/COMPANY Lic. No. F Class
Contractor's Address Contractor's E-mail Address
City � State F_— Zip F— Telephones�� ffi
SETBACKS REAR SETBACKS FRONT PERMIT NO. Dog?.,
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
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USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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