HomeMy WebLinkAboutX2021-0594 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
f Comm'I r Residential City of Newport Beach - Building Division [A
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL \\c
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FGBuilding F_ Grading F—Drainage r Elec F_Mech r Plum CuvdCut r cuvdFill F
Project Address (Not mailing address) f Flood r Fire r, Liq r Landslide F_N/A Floor Suite No
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Description of Work
Use F—ConstType F_
# StoriesF_ # Units (if Res)F—
Valuation $`�'���� f�
Material/Labor)
New/Add5F� RemodelSF�— Garage/New/Add—
OWNER'S NAME Last �j First lo
Owner's Address Owner's E-mail Address
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APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
City State �— Zip F— TelephoneF—
ARCHITECT/DESIGNER'S NAME Last / F !®
t v 1� First �(' 1
Lic. No.
Architect�esigu4r's Address Architect/Designer's E-mail Address
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ENGINEER'S NAME Last First Lic. No.F
Engineer's Address Engineer's E-mail Address
City State F Zip � Telephoned
CONTRACTOR'S NAME/COMPANY Lic.No. L G y 1 CI�a �V
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Contractor's Address Contractor's E-mail Address nV \\ \
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City State I— Zip F Telephoned
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SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. �\
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
LPrint Form I Worksheet for Combo Building & Solar Permit A placation °?E�°°qra
F_ Comm'I F—ResidentialCity of Newport Beach - Building Division 20L� • 0siol ccyroP+
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding i— Grading rDrainage [_ Elec rMech r Plum CuvdCut F_ CuYdFill F_
Project Address (Not mailing address) F Flood r Fire r- Liq r Landslide F_N/A Floor Suite No
Description of Work
Use ConstType �®
# Storiesr— # Units (if Res)F—
Valuation $
Material/Labor
New/Add F Remodel SFF— Garage/New/Add �—
OWNER'S NAME Last
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
City F
State F_ Zip F— Telephone �—
ARCH ITECT/DESIGIN ER'S NAME
Last First
Lic. No. F®®
Architect/Designer's Address
Architect/Designer's E-mail Address
City r
State I®® Zip r Telephoned
ENGINEER'S NAME Last
First F_ Lic. No.F—
Engineer's Address
Engineer's E-mail Address
City I
State �— Zip F Telephone�—
CONTRACTOR'S NAME/COMPANY{F�
Lic. No. -_/•- ci ( Class
Contractor's Address
Contractor's E-mail Address
city El C� C{ (l i < s C
State — Zip r t �E ( Telephone
SETBACKS REAR
SETBACKS FRONT PERMIT N0.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE __ p� _��
DEVELOPMENT NO _ PLAN CHECK FEES $