HomeMy WebLinkAboutX2021-2443 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
r Comm I F_ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL kaoa
F—Building r Grading
F-"Drainage F_ Elec F_ Mech
F Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) I_ Flood
r Fire F_ Liq j— Landslide FN/A Floor Suite No
�2E • I�1�
410<�� � � I F_
Description of Work
Use [_ Const Type F_
# Stories[— # Units (if Res)[ —
Valuation $
Material/Labor
New/AddSFF— Remodel SFF Garage/New/AddF_
OWNER'S NAME
Last �—
First
Owner's Address
Owner's E-mail Address
City
State r—
Zip TelephoneF
APPLICANT'S NAME
Last �—
First'
Applicant's Address
Applicant's E-mail Address
City I
State F
Zip F— Telephoned
ARCHITECT/DESIGNER'S NAME Last First F Lic. No. I
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State
Zip [ TelephoneF
ENGINEER'S NAME
Last F —
First F— Lic No.F
Engineer's Address
Engineer's E-mail Address
City
State _
Zip Telephoned
CONTRACTOR'S NAME/COMPANY y��p`G.n c1CS
rw Orr f�
It4� Lic. No. `0115t�flass �
'u
Contractor's Address
Contractor's E-mail Address
r 'i"o
5
,5
City F �NIf�L
��
State 16
Zip 2.f014 Teleph
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2
SETBACKS REAR
SETBACKS FRONT
• /�t3
PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO. p (0-U2(
USE ZONE
'DEVELOPMENT NO
PLAN CHECK FEES $