HomeMy WebLinkAboutX2021-1300 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application aw
Comm'I F" Residential City of Newport Beach -Building Division XZI -� NOTE: PLAN CHECK FEES nl lF AT nRAF OF.ci IRMITTAI
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Project Address (Not mailing address) F_ Flood F- Fire F- Liq F_ Landslide [N/A Floor Suite No
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Description of Work
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# Storiesr # Units (if Res)
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New/Add SF Remodel SF � �F4
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Valuation $
Material/Labor / B
OWNER'S NAME Last jcz P5k
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Owner's Address
Owner's E-mail Address
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APPLICANT'S NAMELast Avr
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Applicant's Address
Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME LastISC6
Firstl�ly Lic.No. A7 %-
Architect/Designer's Address -
Architect/Designer's E-mail Address
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ENGINEER'S NAME Last S!:� ? -,lr
First!ii R : .. Lic. No ," G
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Engineer's Address
Engineer's E-mail Address
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CONTRACTOR'S NAME/COMPANY 3C Lic. No. Class
Contractor's Address
Contractor's E-mail Address
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SETBACKS REAR SETBACKS FRONT
PERMIT NO. / t
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. ��'
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USE ZONE DEVELOPMENT NO V �U i ��� 1 �j PLAN CHECK FEES.$
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