HomeMy WebLinkAboutX2021-0666 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application 04,10g,Comm'I r Residential City of Newport Beach -Building Division�L, NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITT L
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Description of Work
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OWNER'S NAME Last �7VIQ First �tS 15 5 / DCJO
Owner's Address Owner's E-mail Address P
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APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State r Zip Telephone�—
ENGINEER'S NAME Last ', First F', Lic. No.F!
Engineer's Address Engineer's E-mail Address
City State F___ Zip F_ Telephoned
CONTRACTOR'S NAME/COMPANY �e�tUc��GS�raliq Lic. No. lCc_lus Class
Contractor's Address Contractor's E-mail Address
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SETBACKS REAR SETBACKS FRONT PERMIT NO. \4-z C) C — O t�°v
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $