HomeMy WebLinkAboutX2021-3264 - Permit Application-Print Form 9 Worksheet for Combo Building & Solar Per it Application Vsp,�X Comm I City of Newport Beach - Building Division�' Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUB
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Project Address (Not mailing address) FX_ Flood rX Fire F' Liq IX' Landslide fN/A Floor Suite No
Description of Work
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# Stories[— # Units (if Res)F—
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New/AddSFI �%1 Remodel SF� ,—. Garage/New/Add
Valuations
Material/Labor Vl C1_V v
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OWNER'S NAME Last I r r L �Vu First
Owner's Address �^ n Owner's E-mail Address
City State -- Zip F TelephoneF
APPLICANT'S NAME Last 1' First T V --(o
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Applicant's Address Applicant's E-mail Address
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City State Zip �(P3 Telephon –7 0 ' L c-
ARCHITECT/DELISIGNER'S NAME Last First ' Lic. No.—L� h
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Architect/Designer's Address Architect/Designer's E-mail Address
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G1 Telephone
City 7\/ Stat � Zip (p�2 � a 43'�-
ENGINEER'S NAME LastFirst Lic. No.f
Engineer's Address Engineer's E-mail Address
City State Zip Telephone
CONTRACTOR'SNAMEXOMPANY/ Lic. No. "�IaiQ�tB 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 9✓N DEVELOPMENT NO PLAN CHECK FEES $