HomeMy WebLinkAboutPV2021-185 - Permit ApplicationPrint Form l Worksheet for Combo Building & Solar Permit Application
JX Comm'] iX Residential
City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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fX Building FX Grading 'Drainage fx` Elec FX_ Mech Plum CuvdCut Cu Yd Fill
Project Address (Not mailing address) Fx_ Flood r Fire r Liq fx Landslide FX -N/A Floor Suite No
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Description of Work
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Use
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Const Typett
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# Stories # Units (if Res)s
Valuation $
Material/Labor
New/Add SFI--- Remodel SF�'— --
Garage/New/Add l—,
OWNER'S NAME Last
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First
Owner's Address
Owner's E-mail Address
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CRY ('V"f ;i . ; f` t
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- (' t ; State Zip Ur Telephone—
APPLICANT'S NAME-
Last
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First
Applicant's Address
Applicant's E-mail Address
City
State I
Zip F_ Telephone i !,
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ARCHITECT/DESIGNER'S NAME
Last
First F_ Lic. No. � ---
Architect/Designees Address
Architect/Designer's E-mail Address
city
State �—
Zip [- Telephone)—
ENGINEER'S NAME Last
First Lic. No.F
Engineer's Address
Engineer's E-mail Address
City
State F
Zip Telephoner--
CONTRACTOR'SNAME/COMPANY
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i i- Lic. No. Et if u(i Class
y—
Contractor's Address
Contractor's E-mail Address
City s
State F
ZiP r-- Telephone
SETBACKS REAR
SETBACKS FRONTt,`
L 'Z `
PERMIT N0. � � :_�' = i -•z
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $