HomeMy WebLinkAboutX2021-0559 - Permit Application (2)Print Form Worksheet for Combo Building & Solar Permit Application Ci3q,"W.
p1City of Newport Beach - Building Division W. 0f-j9
IX Comm'I Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rX Building jX Grading
FDrainage FX Elec FX_ Mech F>—� Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) I-X Flood FX Fire jX Liq rj< Landslide FXN/A Floor Suite No
Description of Work
1 —7 3
Use Const Type F -
# Stories[— # Units (if Res)[_
Valuation $
New/Add SF
Remodel SF I� Garage/New/Add F—
Material/Labor
OWNER'S NAME
Last First
Owner's Address
Owner's E-mail Address
City F_
State Zip � Telephonel�
APPLICANT'S NAME
Last First
Applicant's Address
Applicant's E-mail Address
City F_
State F Zip Telephonel�
ARCHITECT/DESIGNER'S NAME Last First I Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
F_
City
State Zip Telephone
ENGINEER'S NAME
Last First Lic. No.F_
Engineer's Address
Engineer's E-mail Address
City
State � Zip FTelephone ��
CONTRACTOR'S NAME/COMPANY Lic. No. F_ Class
Contractor's Address
Contractor's E-mail Address
City
State F Zip r� Telephones
SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $