HomeMy WebLinkAboutX2021-0201 - Permit Application (3)Print Form I Worksheet for Combo Building & Solar Permit Application
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City of Newport Beach -Building Division
Comm'I r Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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# Stories `� # Units (if Res)
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New/Add SF TIC
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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
ity
State 7— Zip F Telephoned
ARCHITECT/DESIGNER'S NAME
Last First F Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State F_— Zip � TelephoneF_
ENGINEER'S NAME Last First r® Lic. No.F_
Engineer's Address
Engineer's E-mail Address
City I
State [_6 Zip [_ Telephone�-
CONTRACTOR'S NAME/COMPANY
p S C Lic. No. &s8-71— Class Q
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Contractor's Address
Contractor's Ea -mail Address
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State �— Zip (� Telephone ?tq (/t/o_ qg3 tf
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SE BACKS REAR
SETBACKS FRONT PERMIT NO. +L(�
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. Ei
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $