HomeMy WebLinkAboutX2021-0818 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Applicati y c`s °YP
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Comm'I ( Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
j"Building F- Grading
F-Drainage r Elec F Mech
r Plum Cu Yd Cutl Cu Yd fill
Project Address (Not mailing address) I_ Flood
f-= Fire F_ Liq F_ Landslide rN/A Floor Suite No
Description of Work
Use F—ConstType F_
# Stories #Units (if Res)
Valuation $
New/Add SFF
Remodel SFF— Garage/New/Add
F
Material/Labor
OWNER'S NAME
Last
First
Owner's Address
Owner's E-mail Address
City
State F_
Zip F_ Telephone[ —
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. F_
Architect/Designer's Address
ArchitecUDesigner's E-mail Address
City
State F_
Zip [_ TelephoneF_
ENGINEER'S NAME
Last
First F Lic. No.r
Engineer's Address
Engineer's E-mail Address
City
State F__
Zip TelephoneF_
CONTRACTOR'S NAME/COMPANY I <� � / ` Lic No. 7 � �ClassF
'-'t (
Contractor's Address
Contractor's E-mail Address -�
City
State C j
Zip �Z� Telephone
SETBACKS REAR
SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO. ' 7 }�
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $
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