HomeMy WebLinkAboutX2021-3423 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
Comm'] Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Suite No
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Valuation
Matedal/Labor
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OWNERS NAME
Last
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Owner's Address " f—.----- I
Owner's E-mail Address
City State �t —�
ZIP f Telephone --'7-" )
APPLICANT'S NAME Last
I First
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Applicant's Address - Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last M I
D J��7I Lic. No. G Cl ly �•
ArchitectIDesigner's Address ArchiteCNDesigner's E-mail Address t
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City Q�� l��k State Zip Lr<j. Telephone C
ENGINEER'S NAME Last
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Engineer's Address �(�{ Engineer's E-mail Address
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CONTRACTOR'S NAME/COMPANY
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Contractor's Address
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City w yr - -- seats C/l
SETBACKS REAR
SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
Contractor's E-mail Address
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�p Telephoned —
PERMIT NO. l (/l ��J Z�
PLAN CHECK NO. 70 C1 C - 7
PLAN CHECK FEES $