HomeMy WebLinkAboutX2022-1641 - Permit ApplicationPrint Form
F Comm'I
J Worksheet for Combo Building & Solar Permit Application
j Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F_Building r— Grading rDrainage r Elec r Mech
r Plum CuYdCut l CuYdFill
Project Address (Not mailing address) F_ Flood
F_ Fire r Liq r Landslide rN/A Floor Suite No
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Description of Work
Use F_ ConstType F_
# Stories? # Units (if Res)F—
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Valuation $
Material/Labor
New/Add SFF Remodel SFF— Garage/New/Add
OWNER'S NAME Last
First
Owner's Address
Owner's E-mail Address
City
State
Zip F_ Telephone[ —
APPLICANT'S NAME Last
w'
First ray
Applicant's Address
Applicant's E-mail Address
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State C�
Zip 4 i aQ Telephone 19l - �_
ARCHITECT/DESIGNER'S NAME
Last
First Lic. No.
Architect/Designer's Address
ArchitecVDesigner's E-mail Address
City
State F_
Zip F Telephoned
ENGINEER'S NAME Last
First F Lic. No.F—
Engineer's Address
Engineer's E-mail Address
City I
State F
Zip �— Telephoned
CONTRACTOR'S NAME/COMPANY
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CiPMContractor's
Contractor's Address
E-mail Address
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State A—
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SETBACKS REAR
SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO. v
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $