HomeMy WebLinkAboutX2021-0867 - Permit ApplicationPrint Form Worksheet for Combo Building &Solar Permit �AJz� ® O� &- -
F Comm'I pplication
F Residential City of Newport Beach -Budding Division �
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) I— Flood Fire j Liq Landslide F_N/A Floor Suite No
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Description of Work 2--� . I
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J?7 v j #Stories #Units (if Res)
New/AddSF[ Remodel SF V[ Valuation$ y p
Garage/New/Add � Material/Labor _/oMR l�
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OWNER'S NAME Last
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Owner's Address First
Owner's E-mail Address
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city
`hKd State
Zip Telephone Telephone L c
APPLICANT'S NAME
Last '%6r.1 Lrr P� First 0
Applicant's Address -
Applicant's E-mail Address
city State
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ARCHITECT/DESIGNER'S NAME
Last First r.-_._._.__
Architect/Designer's Address - Lic. No. r—.----
Architect/Designer's E-mail Address
Dity Stater------- ZiP f� Telephoned_-.--- �
ENGINEER'S NAME Last
First ____ Lic. No.� -
Engineers Address
Engineer's E-mail Address
CltyState F� Zip Telephoner--_��-.�--
CONTRACTOR'SNAME/COMPANY
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Contractor's Address -
�,, Contractor's E-mail Address
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State � Zip I7.�tfo3 Telephone 'l�-�A__—'Toa-coo I
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT PERMIT NO./p ®$Po7
SETBACKS RIGHT O d�
_� PLAN CHECK NO:
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $