HomeMy WebLinkAboutX2021-0282 - Permit ApplicationLPrini Form j * "Worksheet for Combo Building $ Solar Permit Application
(— Comm'] F_ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAI
u4'E�ev„'.m
n
(-Building F_Grading
rDrainage F_Elec rMech F— Plum Cu vd Cut Cu vd Fill
Project Address (Not mailing address) r Flood r Fire r Liq r Landslide F_N/A Floor Suite No
Description of Work
Use ConstType F_
IF Stories # Units (if Res)F
l
Valuation $
Material/Labor
New/Add SFF Remodel SFF
Garage/New/Add �—
OWNER'S NAME
Last
First
Owner's Address
Owner's E-mail Address
City
State [_ Zip F_ Telephoned__
APPLICANT'S NAME
Last
First
Applicant's Address
Applicant's E-mail Address
City r
State F®.
Zip F Telephone F_
ARCH ITECT/DESIGNER'S NAME Last
First F— Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State F_
Zip I Telephoned
ENGINEER'S NAME
Last
First F Lic. No.[ --
Engineer's Address
Engineer's E-mail Address
City
State F_
Zip F_ TelephoneF—
CONTRACTOR'S NAME/COMPANY
Lic. No. — Class
Contractor's Address
Contractor's E-mail Address LOZ J
City
State I
Zip F Telephoned
SETBACKS REAR
SETBACKS FRONT
PERMIT NOMA— 071
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO. — u{
USE ZONE
DEVELOPMENT < O
-��_ u PLAN CHECK FEES,$