HomeMy WebLinkAboutX2021-3324 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application
rX Comm'I CX Residential City of Newport Beach - Building Division 5
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
(X Building Fx— Grading
f> Drainage CX Elec (-X Mech Fx Plum Cu Yd Cut Cu Yd Fill
Project Address (Not
mailing address) fx Flood FX Fire fX Liq FX Landslide IXN/A Floor Suite No
Description of Work
Use Const Type
AAACa
7 _
l
Y"
# Stories[ # Units (if Res)
Valuation $
S
New/Add SF ,�. '" j
Remodel SF I:;' C,- C', Garage/New/Add F— ---
Material/Labor 1 % 6
OWNER'S NAME
Last ��9 First
Owner's Address
Owner's E-mail Address
City
State Zip Telephone
APPLICANT'S NAME
Last �� First �
Applicant's Address
Applicant's E-mail Address
r
City
State -® Zip �� Telephone t b) :S
ARCHITECT/DESIGNER'S NAME Last "Tt'\ First � - Lic. No. .�
Architect/Designer's Address
Architect/Designer's E-mail Address
City
StateF_ Zip Telephone
ENGINEER'S NAME
Last First Lic. No. 4:3_i_Q11
Engineer's Address
Engineer's E-mail Address
City �z 1
State �rr) Zip Telephone '71L
CONTRACTOR'S NAME/COMPANY Lic. No. rj Class
Contractor's Address
Contractor's E-mail Address
City
State Zip F Telephone
SETBACKS REAR
SETBACKS FRONT PERMIT NO. J►�,p�I T ��
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. �• �2,
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $