HomeMy WebLinkAboutX2021-2500 - Permit Application (2)Print Form Worksheet for Combo Building & Solar Permit A I"
( Comm'I j— Residential
City of Newport Beach - Building Division ZZ
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBM A
[—Building r Grading F -Drainage [ Elec r Mech F_ Plum Cu Yd Cut Cu Yd Fill F v
Project Address (Not mailing address) F_ Flood j-" Fire f- Liq r Landslide F_N/A Floor Suite No
I I—I
Description of Work
Use Const Type
# Stories # Units (if Res)r-
Valuation $
Material/Labor
New/Add SF( Remodel SFF—Gara a/New/Add F —
- g -
OWNER'S NAME Last
First
Owner's Address
- Owner's E-mail Address
_
City -_- -
�- State- Zip [_ Telephone[—
elephoneAPPLICANT'S
APPLICANT'SNAME Last
First
Applicant's Address
Applicant's E-mail Address
City
State Zip F Telephoned
ARCHITECT/DESIGNER'S NAME
Last First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State F Zip r Telephone--
ENGINEER'S NAME Last
First F Lit. No. F_
Engineer's Address
Engineer's E-mail Address
e
r
State Zip F Telephone
CONTRACTOR'S NAME/COMPANY
1600 ��J Lic. No. �4Ss Class
4
Contractor's Address
Contractor's E-mail Address C- 10
City sof 17i14/tS
State E ZIP 1 Tfai Telephone 7Z(-) l26`a_
SE. CKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. s
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $