HomeMy WebLinkAboutX2021-1530 - Permit ApplicationPrinr Firm. Worksheet for Combo Building & Solar Permit Application
Comm'! r 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) F Flood f Fire F_ Liq r__ Landslide FN/A Floor Suite No
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Description of Work
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OWNER'S NAME Last mN*, P3 Q Fi
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Owner's Address Owner's E-mail Address
City F_ State F Zip Telephon� �
APPLICANT'S NAME Last ��Nf� First 7O*-W7
Applicant's Address Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Las p ` 1 1tr ty First �rr Lic No. F
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Arch itect/Desiggnerr''ssjAddress ArchitecUDesigneer's E-mail Address
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City State [— Zip Telephone
ENGINEER'S NAME Last [Ili F(— First Vu6(t'l1 1 LicN�
Engineer's Address Engineer's E-mail Address
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City F_ State F— Zip [_ Telephone[�
CONTRACTOR'S NAME/COMPANY [— Lic No. [— Class
Contractor's Address Contractor's E-mail Address
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SETBACKS REAR SETBACKS FRONT PERMIT NO. gz�thl'�2�p
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.vvvr
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $