HomeMy WebLinkAboutS2021-0156 - Permit Application (2)Print Form W sheet for Combo Building & Solar Permit Application nww2
r Comm'I F Residential City of Newport Beach -Building Division t NOTE: PLAN CHECK FEES DUE AT TIME nFRI IRnnITTnI
Building r Grading
ainage rElec �Mech plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) F Flood f- Fire F- Liq` f- Landslide N/A Floor Suite No
Description of Work
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Material/Labor
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OWNER'S NAME Last
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Owner's Address
Owner's E-mail Address
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APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
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State
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ARCHITECT/DESIGNER'S NAME
Last
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_ Lic. No.
Architect/Designees Address
Architect/Designer's E-mail Address
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State -
Zip F..._- Telephone--_-,.--
ENGINEER'S NAME Last
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First F---— Lic. No.F--
Engineer's Address
Engineer's E-mail Address
City
State L—
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Zip r_----- Telephoned
NTRACTOR'S NAME/COMPANY
Lic. No. — Class
ntractor's Address
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Contractor's E-mail Address
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State r---_—
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Zip--.— Telephone
SETBACKS REAR
SETBACKS FRONT
PERMIT NO.�.-�
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO. ;2
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $ _ �'