HomeMy WebLinkAboutX2021-0914 - Permit ApplicationPint Form `:' Worksheet for Combo Building & Solar Permit Application o44` I"'g
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Comm'I ❑ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL `�"••'
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ProjectAddress (Not mailing addresses) ❑ Flood ❑ Fire ❑ Liq [-] Landslide RN/A Floor. Suite No
Description of Work �` I0
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New/Add RemodelSF Garage/New/Add
OWNER'S NAME Last First
Owner's Owne'r's E-mail Address
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City_ y1111\/ State L. Zip t -yip -A Telephone _ ~yp �o
APPLICANT'S NAME Last L First
Applicant's Address Applicant's E-mail Address
Telephone l TT - r
City X71"M`�f%.- State �; � ZipCi
E-176161
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ARCHITECT/DESIGNER'S NAME Last First )TG� Lic.No.�.
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Architect/Designer's Address Architect/Designer's E-mail Address
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City_ , Lt13 State 7,T71 Zip TJT(, .6Telephone
ENGINEER'S NAME Last First Lic. No.�
Engineer's Address Engineer's E-mail Address -
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City State �� Zip F7-11 Telephoned
CONTRACTOR'SNAME/COMPANY /h �_ t>l: )>I Lic.No. 31CI ��,��,(((((( Class �j e
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Contractor's Address 'LII'L'tG�t oWLW�SmJ&L
j State I �J',, Zip q� ) Telephone
City I �h�
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SETBACKS REAR SETBACKS FRONT _ PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. �% • WV%/
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USE ZONE DEVELOPMENT NO ,,,�}- ,Spm PLAN CHECK FEES $
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