HomeMy WebLinkAboutE2021-0084 - Permit Applicationnot FormEWA
"Worksheet for Combo Building &Solar PerlTiit`App)Ft;atiorr
F_ Comm'I f- Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL o ."
Buildi '
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Project Address (Not mailing
address) F_ Flood f , Fire F Liq F- Landslide FN/A Floor Suite No
300
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Description of Work
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Valuation
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Material/Laa bor
OWNER'S NAMELast
First_I''
Owner's Address
Owner's E-mail Address
City
State Zip F_,, Telephoned
APPLICANT'S NAME Last
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Applicant's Address
Applicant's E-mail Address'
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City r-cx cf�u CUcavn�n�q State Ccl Zip FC1173.Telephone LC•-Z7/-ji3`j
AREMIT!Gi/DESIGNER'S NAME
Last First Lic. No.
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Architect/Designer's Address
Archite ct/Designer'sE-mail Address
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City
State r.� ZiP Telephone
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ENGINEER'S NAME Last
FirstLic.Lic. Nof—'
Engineer's Address
Engineer's E-mail Address
City �—
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State r Zip Telephone
CONTRACTOR'S NAME/COMPANY
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Contractor's Address.
Contractor's E-mail Address
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State C Zip 9 r 73 � Telephone CZ 6; _ 2
SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $