HomeMy WebLinkAboutX2021-3374 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit A iplicati
r— comm -I P<Residential City of Newport Beach - Building Division Y 393 7 Lt
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) F_ Flood F-, Fire f—, Liq F_ Landslide FN/A Floor Suite No
Description of Work
Use Const Type
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#Stories # Units (if Res)
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Valuation
New/Add SF NA � Remodel SFF Garage/New/AcicIF7�
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Material/Lab ab r
OWNER'S NAME Last First... I
Owner's Address Owner's E-mail Address
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City Telephone
State F ZipF7 FKO�23O-4
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
City State F ----ZIP Telephonel
ARCHITECT/DESIGNER'S NAME Last First F Lic. No.
Architect/Designees Address Architect/Designer's E-mail Address
City State Zip Telephone
ENGINEER'S NAME Last First Lic. Nol
Engineer's Address Engineer's E-mail Address
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City l ru t C State V _6 ZipFc,t-?_ta�y', Telephonel cv.-2_-2_c
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CONTRACTOR'S NAME/COMPANY pp,, Lic. No. Class
Contractors Address Contractor's E-mail Address
city State F Zip I Telephonel
SETBACKS REAR SETBACKS FRONT PERMIT NO. 'kZQZ/t 3*57 (q-')
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. 2
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USE ZONE DEVELOPMENT NO PLAN CHECK FEES $ '�54 e 7 t,