HomeMy WebLinkAboutX2021-0297 - Permit Application"` PnnE`Forrr 7 .' Worksheet for Combo Building -& Solar Permit Application o�E�Po�a
City of Newport Beach - Building Division .
F Comm'I esidentiaf NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTALS ' O yA a
r,Building 'i Grading Drainage Elec l-Mech r Plum CuvdcutF7 Cu Yd Fill
Project Address (Not mailing address) F Flood f7 Fire Fi Liq F_ Landslide I iN/A Floor II Suite No
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Description of Work
Use Const Type
d # Stories[ # Units (if Res)F
valuation $
New/AddSFF Remodel SF177:7— Garage/New/Add —, Material/Labor
OWNER'S NAME Last J First
Owner's Address Owner's E-mail Address
r 7 {
cityI State ---- Zip Telephoner
APPLICANTS NAME Last �/ First y'
Applicant's Address Applicant's E-mail Address
City , i State FT Zip r " Telephone -- --
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State Zip �_— Telephoner
ENGINEER'S NAME Last First Lic. No.7-7—
Engineer's Address Engineer's E-mail Address
City State Zip �- Telephone�—
CONTRACTOR'S NAME/COMPANY /! Lic. No. Classy
r.:
Contractor's Address Contractor's E-mail Address
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City j State
/ Zip r, r Telephone
SETBACKS REAR
SETBACKS LEFT
USE ZONE
SETBACKS FRONT PERMIT NO.
SETBACKS RIGHT PLAN CHECK NO.
DEVELOPMENT NO PLAN CHECK FEES $ -