HomeMy WebLinkAboutX2021-1991 - Permit ApplicationPrIFrE�ortn Worksheet for`Corrlbo Building $ Solar Permit Application "@Fxe" °tee
City of Newport Beach - Building Division
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing
address) Vlood ❑ Fire l Liq [I Landslide F IN/A Floor Suite No
Description of Work
Use F—Const Type
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6
# Storiesl— # Units (if Res)F—
Valuation $
New/AddSF� J RemodelSF�(p—' Gar a/New/
Material/LaborF11(15J
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OWNER'S NAME Last U9�iN First
Owner's Address
Owner's E-mail Address
,Zip
City )_ew7PaA-{ Week - l
State
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APPLICANT'S NAME Last First LD
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 Zip Telephone
ENGINEER'S NAME Last
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% ' First 17/n/' Lic. No.
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Engineers Address
Engineer's E-mail Address
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City / „ UN0. �%5_
State �- Zip 9.ta 5 3- Telephone
CONTRACTOR'S NAME/COMPANY
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Contractor's Address
Contractor's E-mail Address
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State �^ Zip 9 y� Telephone
9 99�f1-�033.
SETBACKS REAR SETBACKS FRONT PERMIT NO.
Ole 060
SETBACKS.LEFT SETBACKS RIGHT: PLAN CHECK NO.