HomeMy WebLinkAboutX2021-1197 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar 'Permit Application' eE r
( Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FFFC ni jr AT TIRAC nC of iMAAA
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Project Address (Not mailing address) I— Flood F Fire F'Iiq r Landslide FN/A Floor Suite Suite Nl
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Description of Work
Use Const Type F
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# Stories o # Units (if Res)F
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Valuation $
Material/Labor ✓ J�
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LC/Add SF r . 7& Remodel SFI�-- g� Add
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OWNER'S NAM Last First
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Owner's Address
Owner's E-mail Address
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City State C ZiP j Telephone
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APPLICANT'S NAME Last `
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Applicant's Address
Applicant's E-mail Address
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City State C Zip Telephone
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ARCHITE / SIGNER'S NAME Last ;�� t 6 r
First �, Lic. No
Architect/Designer's Address Architect/Designer's E-mail Address
City State Zip -T�,(�;
3 Telephon
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ENGINEER'S NAME Last ,1� ! I First T C �
G T/ Lic No.
Engineer's Address Engineer's E-mail Address
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City ��VI N � State Zip dl D Telephone
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CONTRACTOR'S NAME/COMPANY Lic. No. �p Classi�—
Y� W� „Contractor's
Contractor's Address E-mail Address
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City State �b Zip F— Telephone F—
SETBACKS REARARYBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $