HomeMy WebLinkAboutX2021-2732 - Permit Application(�
Print Form Worksheet for Combo Building & Solar Pe u v tion%V
[- Comm'I [- Residential City of Newport Beach - Building Div
isi U V
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
[—Building [- Grading [—Drainage [-Elec [-Mech [- Plum Cu Yd cut Cu Yd Fill F_
Project Address (Not mailing address) [- Flood [- Fire [- Liq [- Landslide [-N/A Floor Suite No
Description of Work
Use F—Const Type F—
# StoriesF_ # Units (if Res)[—
Valuation $
Material/Labor
New/Add SFF— Remodel SFF— Garage/New/Add r----
OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
City State I Zip �--_-- Telephone
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
City State F—. Zip F_ Telephoned-
ARCHITECT/DESIGNER'S NAME Last First I-- Lic. No.
Architect/Designees Address Architect/Designer's E-mail Address
City State 7— Zip F— Telephone
ENGINEER'S NAME Last First I— Lic. No.F_
Engineer's Address Engineer's E-mail Address
City State I— Zip F_ Telephoned—
CONTRACTOR'SNAME/COMPANY r Lic. No. �7/���Class�
ss
Contractor's Address Contra is E-mail Addre49
2-2, i auv-&.j/Saulej-jO-,s - Nel-
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city V n�.�yL �/ State Q— Zip t Telephone F c/
REAR SETBACKS FRONT PERMIT NO.
LEFT SETBACKS RIGHT PLAN CHECK N0.
E
DEVELOPMENT NO PLAN CHECK FEES $