HomeMy WebLinkAboutX2021-2036 - Permit Application (2)Pant Form Worksheet for Combo Building & Solar Permit AN ation
F_ Comm'I r Residential City of Newport Beach - Building Division XZa -WIN
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
I—Building F_ Grading rDrainage [ Elec r Mech Plum Cu Yd Cut Cu Yd Fill
Address (Not mailing address) C Flood
X11 U"
of Work
I— Fire F_ Liq f— Landslide
New/AddSFF77__ SFF77777 Garage/New/Add
OWNER'S NAME Last
Owner's Address
City
APPLICANT'S NAME Last
First I
Owner's E-mail Address
State Zip
rN/A Floor Suite No
Use F Const Type 177
# StoriesF_ # Units (if Res)F_
I vvY
Applicant's Address
City State
First
Applicant's E-mail Address
----- —
Zip I - -- Telephoned
ARCHITECT/DESIGNER'S NAME Last I First F77777 Lic. No. F7777
Architect/Designees Address
. - -- _.... -
City �— State F
Architect/Designer's E-mail Address
- _-.-.-...- ---
ZipF—
Telephoned
ENGINEER'S NAMELast First ��, Lic. No.F—
Engineer's Address
City State
Engineer's E-mail Address
-- .-
Zip Telephone
CONTRACTOR'S NAME/COMPANY Lic. No. lass
Contractor's Address Contractor's E-mail Address
rAtJC�®�%r1/f/�r�O�
City I State GA Zip a/2 a/ Telephone (j i,
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
PERMIT NO.
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
M-1 W -i