HomeMy WebLinkAboutX2021-0529 - Permit Application.Print Form Worksheet for Combo Building & Solar Permit Application
01_11�101qif Comm'I residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
7Descriptlon
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New/Add SF Remodel SFF— Garage/New/Add — Valuation $
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OWNER'S NAME Last
First
Owner's Address
Owner's E-mail Address
City State - -
Zip G � t k ' w
TelephonerGjq I, z�� . 0 7,0
APPLICANT'S NAME Last/
Applicant's Address Applicant's E-mail Address
City C r�'l State 7A Zi
P % � �� �' Telephone `I rl I - % - C S' `-
ARCHITECT/DESIGNER'S NAME
LastOt EAU First r
��1C Lic. No. �'- �(
Architect/Designer's Address Architect/Designer's E-mail Address
City State F_
ZIP F_ Telephone
ENGINEER'S NAME Last �3
Gr First DA Te Lic.No.G '_5C�-6! 7
Engineer's Address Engineer's E-mail Address /
1 16"" 577 . L'N i`r , rr
C c Vi. 1
City fi NT A At -A, State C—
Zip cq 2''6{ Telephone "7 1 9 , 3_ 5�
CONTRACTOR'S NAME/COMPANY TIF 1
Lic. No. F_ Class
Contractor's Address Contractor's E-mail Address
City I State F— Zip I TelephoneF�
SETBACKS REAR SETBACKS FRONT
PERMIT NO. �0 Z
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. 2 z
USE ZONE Qcf57,—
- -.- -. - DEVELOPMENT NO PLAN CHECK FEES $
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