HomeMy WebLinkAboutX2021-2604 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
I- Comm'I <Residential City of Newport Beach - Building Division K20?-2Uoq
c�rrLl - Zl SYl NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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I -Building [Grading (Drainage j-Elec Mach F -Plum CuvdCut CuvdFill�
Project Address (Not mailing address) F Flood I— Fire F_ Liq F- Landslide rN/A Floor Suite No
Description of Work Use I— Const Type
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# Stories # Units (if Res)
Yg OF Valuation
New/Add SFI (U� Remodel SF Gara a/New/Add Material/Laa
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OWNER'S NAME Last r ( First fL/�_,
Owner's Address Owner's E-mail Address
City �Zc_ State (��- Zips Telephoner�� (L
APPLICANT'S NAME Last
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Applicant4's Address i ��"� Applicant's E-mail Address
City State �— Zip F---- Telephone[—
ARCHITECT/DESIGNER'S NAME Last p First //
�l C'✓�. _ _. Lic. No. rl.'
Architect Designer's Address Architect/Designer's E-mail Address
City State Zip I Telephone
ENGINEER'S NAME Last First F Lic. No.�—
Engineer's Address Engineer's E-mail Address
City State ZipF Telephoner____—
CONTRACTOR'S NAME/COMPAN
Y Lic. No. �— Class
Contractor's Address ✓ )c , Q � ctor's E-mail Address
City State �— Zip Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO. )� Lam" ✓l �GC3 �I
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. o Z
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $