HomeMy WebLinkAboutX2021-2283 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application sa-WMy"
F_ Comm'I F- Residential City of Newport Beach - Building Division ����, Q 3NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
[Building F- Grading
["Drainage F- Elec r-Mech F- Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing -,address) r- Flood F_ Fire F_ Liq F- Landslide FN/A Floor Suite No
Description of or
,
Use ConstType
✓
#StoriesF_ # Units (if Res)F_
Valuation $ [#fvfNew/Add
Material/Labor
SFF
RemodelSFIU0O Garage/New/AddF
OWNER'S NAME Last j First
Owner's Address
Owner's E-mail Address
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City L+-- �..�
%/ 77
State �� Zip F �tL�Gym�"-� Telephone G�
APPLICANT'S NAME
Last < Z First W
Applicant's Address
Applicant's E-mail Address
City
State Zip ,Ll Z, Telephone ,�' A�zl/6,
ARCHITECT/DESIGNER'S NAME Last AJ First r Lic No.
Arch�itect/Designer's Addresi,
Architect/Designer's E-mail Address
City I,.Z:::�_ '� sV�-t-
Mate 6 D� Zip .-- Telephoned
ENGINEER'S NAME
Last � First F_ Lic. No. F_
Engineer's Address
Engineer's E-mail Address
City
State Ia Zip TelephoneF—
CONTRACTOR'S NAME/COMPANY
Lic. No. F Class
Contractor's Address
Contractor's E-mail Address
City
State F- Zip Telephoned
SETBACKS REAR
SETBACKS FRONT PERMIT NO,
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. U '
USE ZONE
DEVELOPMENT NO U I/ PLAN CHECK FEES $
Mq_ 101A
II