HomeMy WebLinkAboutX2021-1569 - Permit ApplicationPrint For Worksheet for Combo Building & Solar Perm t 11 a ions
now F_ Comm'I F_ Residential City of Newport Beach - Building DivisionNOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTA
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Project Address (Not mailing address) I- Flood F_ Fire [_ Liq r- Landslide r_N/A Floor Suite No
Description of Work
Use Const Type
# StoriesF # Units (if Res)F_
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OWNER'S NAME Last
First
Owner's Address
Owners E-mail Address
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p � Telephone _.. ....
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APPLICANT'S NAME Last W `z
First 'C i
Applicant's Address
Applicant's E-mail Address
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Zip I if?,ZC?q Telephone 5 <f Q g03 •-/61
ARCHITECT/DESIGNER'S NAME Last '(j�"2/
_ First F bNLY !. Lic. No. F_
Architect/Designer's Address
ArchitectlDesigner's E-mail Address
City State----
Zip I---" TelephoneF�
ENGINEER'S NAME Last✓h f�$d�
E
Fi stti A4' u—) <S Li c No.
Engineers Address ,
Engineer's E-mail Address
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City _.._ _..... _. _. _. State �—
Zip— Telephone
CONTRACTOR'S NAME/COMPANY
a Lic. No. ? )G r Class
At�1�'.
Contractor's Address
Contractor's E-mail Address zi
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Zip TelephoneF94%
SETBACKS REAR SETBACKS FRONT
PERMITNO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $