HomeMy WebLinkAboutX2021-3329 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application o EWa°qm
F Comm'I F Residential City of Newport Beach - Building Division " r
TE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL '—
FBuilding Grading�
Drainage Elec ech
um CuvdCut _CuYdFill�
Project Address (N
ng address) Flood
Fire r Liq Landslide rN/A Floor Suite No
or
3 -7 U F �—
Description of Work
Use nstTyp
# Sto es # Units (i s)
Valuation $
Material/Labor
New/ dd SR Remodel SF 7`� Garage/New/Add
OWNER'S NAME
Last
First
Owner's Address
Owner' -mail Address
®1O®—
%
(7 [
City
State f
ZipFL'Telephone
APPLICANT'S NAME
Last
First
Applicant's Address
Applicant's E-mail Address
City
State �
Zip Telephoned
ARCHITECT
L st (l +
First /` Li�No.�
Architect/Designees Address
`✓
Architect/Designer's E-mail Address
City �
State ��
Zip F— Telephoned
ENGINEER'S NAME
Last n1 I
First f% ,' Lic.No. �f
Engineer's Address
Engineer's E-mail Address
City
State F_
Zip F_ Telephone .
CONTRACTOR'S NAME/COMPANY
Lic. No. F_Class
Contractor's Address
Contractor's E-mail Address
City �
State F_
Zip F_ Telephoned
SETBACKS REAR
SETBACKS FRONT
PERMIT NO. VaA
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO. C '
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $