HomeMy WebLinkAboutX2021-2726 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
r Comm'I r Residential City of Newport Beach - Building Division
NOTE:PIAN CHECK FEES DLIF AT TIMF nF ci iRnniTTni
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Project Address (Not mailing a reSS) r Flood r Fire Liq f Landslide / r ,Suite No
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Description of Work"o
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Use Const Type
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#Stories #Units (if Res)
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Material/Labor
New/Add SFF Remodel SF ageVtCV/
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OWNER'S NAME Last `/ First F�
Owner's Address Owner's E-mail Address
City State— r�" off/ [ 7 �� - �� /
Zip Telephone
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
City F— � State F_ Zip F— Telephone
ARCHITECT/DESIGNER'S NAME _j
Last M6 First Lic. No.
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Architect/Designer's Address Architect/Designer's E-mail Address
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City t � ���---..— State F . Zip Telephone �//� 3o.X � 7y 7
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ENGINEER'S NAME Last a' _ First r3r Lic NC
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Engineer's Address Engineer's E-mail Address
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City I-.- �A.�.-� State F7;A-� Zip 9 Telephone 6ClCf.
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CONTRACTOR'S NAME/COMPANY 6I )y L , / r) i� Lic No. 21261 cla/ss F —
Contractor's Address Contractor's E-mail Address
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City �` �% ..>/J6 r D lcv State �` Zip �C,>� Telephone J� 3 7. D c C�J� �63 Y
SETBACKS REAR SETBACKS FRONT PERMIT NO. �Q 1/ - 2
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SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. n
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $