HomeMy WebLinkAboutX2021-2036 - Permit ApplicationPrint Form j Worksheet for Combo Building & Solar Permit AppliSation
City of Newport Beach - Building Division X`2
F_ Comm'I r Residential g X (�Q 70310
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F—Building r Grading
Address
of Work
r"Drainage F_Elec F_Mech Plum CuvdCut CuvdFill F
mailing address) f— Flood r Fire r Liq r Landslide rN/A Floor Suite No
� I 1 Uvi.elo F__ F--
New/Add SFF— Remodel SFF Garage/New/Add
OWNER'S NAME Last
Owner's Address
First
Use ConstTypeF
# Stories # Units (if Res)F
Owner's E-mail Address
City State Zip F— Telephoner—
APPLICANT'S
elephoner
APPLICANT'S NAME Last
First
Applicant's Address Applicant's E-mail Address
City State F Zip �— Telephone[
ENGINEER'S NAME Last a First Lic. NoT—
Engineer's Address Engineer's E-mail Address
City State F Zip TelephoneF—
CONTRACTOR'S NAME/COMPANY F &621N Lic. No. :T Mass
Contractor's Address Contractor's E-mail Address
6',,t Grol ,N��i/,Ca,�
CityState � Zip l 2 / Telephone G�
C
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
PERMIT NO.
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
101 W1
Valuation $
Material/Labor
Owner's E-mail Address
City State Zip F— Telephoner—
APPLICANT'S
elephoner
APPLICANT'S NAME Last
First
Applicant's Address Applicant's E-mail Address
City State F Zip �— Telephone[
ENGINEER'S NAME Last a First Lic. NoT—
Engineer's Address Engineer's E-mail Address
City State F Zip TelephoneF—
CONTRACTOR'S NAME/COMPANY F &621N Lic. No. :T Mass
Contractor's Address Contractor's E-mail Address
6',,t Grol ,N��i/,Ca,�
CityState � Zip l 2 / Telephone G�
C
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
PERMIT NO.
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
101 W1