HomeMy WebLinkAboutX2021-3140 - Permit Application (2)Worksheet for Combo Building & Solar Permit Ap licatio
9sidential CRY of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
'ading F—Drainage F— El Mechr7 plum Cu Yd Cut
Cu Yd Fill
Description of Work
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Flood- F-, Liq f— Landslide r_N/A Floor -
New/Add SFI 11111 Re,
SF---.— 7— Remodel SF
arage/New/Add
OWNER'S NAME Last
I_ First
Suite No
F_
Use F-11 Const Type [--7—[
# StoriesF_ # Units
lf Res)
Valuation $
Material/Labor
Owner's Address
I Y/A F-(j'bo Owner's E-mail Address
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Zip 2,
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APPLICANT'S NAME Last
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Applicant's Address
City State FA
ARCHITECT/DESIGNER'S NAME
A
.0124AW
First I'DE
Applicant's E-mail Address
Zip Telephone
TelhA�
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Last First
s
Architect/Des! n r' Address ucress,
City state
Lic. No. �-
Architect/Designer's E-mail Address
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ZIP C� -;�4, 6 73 T eleph one[ c3
ENGINEER'S NAME Last First 7-7 Lic. No.
Engineer's Address
Engineer's E-mail Address
City State Zip --Telephone
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CONTRACTOR'S NAME/COMPANY
16 Lic. No. oos�ss
Contractor's Address R,2)7T.
Contractor's E-mail Address
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City [o(-O'kv-) e State
Zip TM4-eq Telephone izliq
SETBACKS REAR _ SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO•
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEES $
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