HomeMy WebLinkAboutX2021-2807 - Permit Application (2)12021- 2 90+
Worksheet for Combo Building & Solar Permit Application
F j Comm'I F Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding ❑Grading rDrainage ❑Flet rMech[Plum cu yd cut
Project Address
Description of Work
New/AddSFF— Remodel SFr
OWNER'S NAME Last
Owner's Address
Flood[ Fire n Liq n Landslide
Cu Yd Fill
❑N/A Floor Suite No
Use n ConstTypel
# Stories[) # Units (if Res)'
�I Valuation $
Garage/New/Add L Material/Labor -- — _— J
First
Owner's E-mail Address
City ��� State Zip Telephone
APPLICANT'S NAME Last
Applicant's Address
i
City State
First
Applicant's E-mail Address
Zip �� Telephoned
ARCHITECT/DESIGNER'S NAME Last First
Lic. No.
Architect/Designer's Address
City J State
Architect/Designer's E-mail Address
Zip �� Telephoned
ENGINEER'S NAME Last �— First j Lic. No.F
Engineer's Address
City �— State �-
- -i
Engineer's E-mail Address
Zip �— Telephone— (��(
CONTRACTOR'S NAME/COMPANY Lic. No. �j�(�� I Classy
Contractor's Address
I
City �— State F
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
Contractor's E-mail Address
Zip I Telephone
PERMIT NO.
PLAN CHECK NO. vom 'TALI
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $