HomeMy WebLinkAboutX2021-2223 - Permit Application (2)Print Form <I Worksheet for Combo Building $ Solar Permit Application Cl� PoRm
FX_ Comm'I r" Residential City of Newport Beach - Building Division X202 -Z2�
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Description of Work
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#Stories # Units (if Res)
Valuation $
Material/Labor12 I 000
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OWNER'S NAME Lastf---ar
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Owner's Address
Owner's E-mail Address
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APPLICANT'S NAME Last
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Applicant's Address
Applicant's E-mail Address
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ARCHI ECT/DESIGNER'S NAME
Lic
Last Y,•' t First �U` ✓ l u
V, . No.
Architect/Designer's A ress
ArchitecUDesigne -mail Address
City
State F � Zip �— Telephoner
ENGINEER'S NAME Last
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Engineer's Address
Engineer's E-mail Address
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CONTRACTOR'SNAME/COMPANY
Lic. No.��12C Class
Contractor's Address
Contractor's E-mail Address
City
State F_ Zip �- Telephoned ""
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SETBACKS REAR
SETBACKS FR IT NO.
SETBACKS LEFT
PLAN CHECK NO.
SETBACKS RIGHTt[W-W
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $