HomeMy WebLinkAboutX2021-3247 - Permit ApplicationRrint Form''' . Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division
[� Comm'I Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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F_!Building r—) Grading ` ge I Elec �Mech � Plum cuvdCute cuYdFiu 17-1
Project Address (Not mailing address) ( l Flood f- Fire Liq j J Landslide 11N/A Floor Suite No
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Description of Work
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Use I Const Type n
..J4(t 1t>i_,. j! ICOLD DdA- ,')tea
# Stories # Units (if Res)
Valuation $
Material/Labors +v3oc)
New/Add SF ! Remodel SF J Garage/New/Add'
OWNER'S NAME Last r First
Owner's Address Owner's E-mail Address
CState city �� (�. ,
_ c ' � ' �� Zip ( i; Telephone
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
City I State Zip F Telephone
ARCHITECT/DESIGNER'S NAME Last First �i Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
city �bt�1 G1, 1 th Yi✓_ State Zip F -� Telephone
ENGINEER'S NAME Last -__I First Lic. No.
Engineer's Address Engineer's E-mail Address
i
City l� State; Zip Telephone
CONTRACTOR'S NAME/COMPANY Y Lic. No. ; Class (' .
Contractor's Address Contractor's E-mail Address
City 0 State 1 Zip < Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $