HomeMy WebLinkAboutX2021-1293 - Permit ApplicationPrint Form_ Worksheet for Combo Building & Solar Permit Application
F Comm'] IResidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rt building r Grading rDrainage r Elec (— Mech ' Plum CuYdCut CuYd Fill F
Project Address (Not mailing address) r Flood r Fire r Liq r Landslide FN/A Floor Suite No
Description of Work
Use F—ConstType--
d (uc f
# Stories # Units (if Res)[ —
Valuation $
Material/Labor
New/Add SF F__ Remodel5FF— Garage/New/AddF—
OWNER'S NAME Last
First
l• 1,
Owner's Address
Owners E-mail Address
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�So N�'tss �n
- - - --
City l (; State
Zip r(,i-1—��b L— Telephone
l 6First
APPLICANT'S NAME Last
Applicant's Address
Applicant's E-mail Address -
City State F--
Zip F TelephoneF_
ARCHITECT/DESIGNER'S NAME Last k i�P r\ QZ FirstTZ — Lic. No.
Architect/Designers Address
Architect/Designees E-mail Address `2, I O3 Q
City'��1/Q(tC�
State
V \
Zip ��.�t ($ Telephone �L tr
J 6
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NGINEER'S NAME Last
First �— Lic. No.F —
Engineer's Address
Engineers E-mail Address (),16 %/1
City State F_
Zip F_ Telephoned
ONTRACTOR'SNAME/COMPANY
Lic. No. F Class
Contractor's Address
Contractors E-mail Address
City �— State F
Zip F_ TelephoneF_
SETBACKS REAR SETBACKS FRONT
PERMIT NO. A ?4Z3 —dZQ
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. "S' '" 20 Z 11
USEZONE DEVELOPMENT NO
PLAN CHECK FEES$