HomeMy WebLinkAboutX2021-2097 - Permit Application (2)Print For Worksheet for Combo Building & Solar Permit Application
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F_ Comm'I 7 Residential City of Newport Beach - Building DivisionX//�J�J(�I�NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTfAL" D
Building [;Grading f -Drainage [Elec F_Mech F-PlumcuvdCut r cuvdFill
Project Address(Not mailing address) F_ Flood r Fire r Liq f- Landslide [_N/A Floor Suite No
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Description of Work
Use F—ConstType F
# Stories #Units (if Res)r—
f I?Valuation $
Material/Labo
New/Add SF � Remodel SF I
r -
Garage/New/Add rI
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OWNER'S NAME Last O'5A40-A _....
... _ First A -"D Y __ __.. _...... `
Owner's Address
Owner's E-mail Address
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City j\ }y, ,PD�.T _ State � Zip'43�116V 0— Telephone
APPLICANT'S NAME Last First
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Applicant's Address
Applicant's E-mail Address
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City �� State F�
Zip j2(0�3 Telephoner�Saiav
ARCHITECT/DESIGNER'S NAME Last
First—Lic. No. r—'
Architect/Designer's Address
Architect/Designer's E-mail Address
t\
City State F_
Zip F— Telephoned`-
ENGINEER'S.NAME Last
First F_ Lit. No.F_
Engineer's Address
Engineer's E-mail Address
City State F
Zip F-- Telephone`
CONTRACTOR'S NAME/COMPANY
Lic No. F Class
Contractor's Address
Contractor's E-mail Address
City _. State r---'
Zip F--- Telephone
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. y
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $
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