HomeMy WebLinkAboutX2021-2115 - Permit Application (2)Print Form <Q Worksheet for Combo Building & Solar Permit Application 01,� Comm'I �' Residential City of Newport Beach - Building Division�1�W-21NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMI 0
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Description of Work
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Stories # Units (if Res)s
Valuation $
Material/Labor
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OWNER'S NAME Last _ (h�
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Owner's Address
Owner's E-mail Address
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APPLICANT'S NAME Last I L>c
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Applicppa1nfs Address
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ARCHITECT/DESIGNER'S NAME Last1 G � •_
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Architect/Designees Address
Architect/Designer's E-mail Address
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ENGINEER'S NAME Last
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Engineer's Address
Engineer's E-mail Address
City State
Zip �— Telephoned
CONTRACTOR'S NAME/COMPANY 17
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Contractor's Address
Contractor's E-mail Address
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SETBACKS REAR SETBACKS FRONT
PERMIT NO.Z k I S
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. t �j31 — ZeTv(
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $