HomeMy WebLinkAboutX2021-3140 - Permit Application&2 -0a[ -3N0
Print Form Worksheet for Combo Building & Solar Permit Application
r Comm']Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) C Flood F_ Fire F— Liq F— Landslide FN/A Floor Suite No
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Description of Work
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#Stories #Units (if Res)
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Valuation $ o A�
Material/Labor (JL/
New/Add SF Remodel SF
Garage/New/Add
OWNER'S NAME Last ✓ kG1
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Owners Address
Owner's E-mail Address
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State Zip ,7A -,.. &:�> Telephone[(?6�
APPLICANT'S NAME Last
First
Applicant's Add ess
Applicant's E-mail Address
city
Stat Zip Telephone (:?�,4,C0 (' (� 8 d
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ARCHITECT/DESIGNER'S NAME Last
Lic. No.
First F_
F_
Address
Architect/Designer's E-mail Address
City _ _
State-- Zip---', Telephone
ENGINEER'S NAME Last
First Lic. No.F_
Engineer's Address
Engineer's E-mail Address
City
State I Zip F Telephoned
CONTRACTOR'S NAME/COMPANY
Lic. No. �— Class
Contractor's Address
Contractor's E-mail Address
City
State F_ Zip F_ Telephone'
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $