HomeMy WebLinkAboutX2021-2989 - Permit Application_Print Form Worksheet for Combo Building & Solar Permit Application
F Comm'I r[j' Residential City of Newport Beach - Building Division
f� NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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ascription of Work
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OWNER'S NAME Last ZII_ C�TIT
Owners Address
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APPLICANT'S NAME Last (I Mi r-Lra
First
Owner's E-mail Address
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Applicant's Address Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last
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ArchitectIDesigner's Address Architect/Designees E-mail Address
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ENGINEER'S NAME Last ftfocqi
Engineers Address
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CONTRACTOR'S NAME/COMPANY
Contractors Address
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Engineer's E-mail Address
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Contractors E-mail Address
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itate �— Zip t� Telephone tl 2j��._ 1 35 Y
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $