HomeMy WebLinkAboutX2021-3114 - Permit Applicationnt Form _j Work -sheet for Combo Building & Solar Permit Application port
omm'I r Residential City of Newport Beach - Building DivisionNOTE; PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F—Building r Grading
j—Drainage rElec rMech F" Plum Cu Yd Cut Cu Yd Fill l
Project Address (Not mailing address) r— Flood F_ Fire I— Liiq f— Landslide I _N/A Floor Suite No
Description of Work
Use F—Const Type
#Stories #Units (if Res)F
L1
Valuation $
Material/Labor
New/AddSFF
Remodel SF�— Garage/New/Add
OWNER'S NAME
Last C e rc, 1 , e__ First
Owner's Address
Owner's E-mail Address
City
State F— Zip F TelephoneF-----
APPLICANT'S NAME
Last First
Applicant's Address
Applicant's E-mail Address
City State F Zip F— Telephone[_7�
ARCHITECT/DESIGNER'S NAME Last First Lic. No. �—
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State Zip 7-7— TelephoneF—
ENGINEER'S NAME
Last First Lic. No.F—
Engineer's Address
Engineer's E-mail Address
City
State F Zip Telephoner
CONTRACTOR'S NAME/COMPANY
(� 0—✓t � l L Lic. No. C1 2 2_3C Class J;
Contractor's Address
Contractors E-mail Address
City e__ �P,7 �
State E,4� Zip ci 2 (:. `j% Telephone
SETBACKS REAR
SETBACKS FRONT PERMIT NO. XZOZI 3I I�
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. 11 ' i i)
USE ZONE
DEVELOPMENT NO �_ PLAN CHECK FEES $