HomeMy WebLinkAboutX2021-0029 - Permit Application=rint Form Worksheet for Combo Building & Solar permit Application Sfk�
Comm City
of Newport Beach - Building DivisionIJ�j p1�I Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL{ (/ �
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Project Address (Not mailing address) ❑Flood �i Fire Li Landslide Floor Suite No
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Description of Work
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# Stories l l # Units (if Res)F_I
Valuation
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OWNER'S NAME Last '...1<1--�--,,.�
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Owner's Address E-mail Address
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APPLICANT'S NAME Last C i.1/i: .I First
Applicant's Address ff-- Applicant's E-mail Address
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State �/��
City 7 " ii L; f" Zip i z. �j,Ci ( Telephone T- - (( j.i,
ARCHITECT/DESIGNER'S NAME11 I -
Last _ / � st til Lic. No.
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chitesi ner's) Address
Architect/Designer's ner's Address Ar
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City, _ )- itl (r� State L ZIp �'�.�, r �� Telephone ����� (,1� _.
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ENGINEER'S NAME Last' - -- First - - Lic. No-
Engineer's Address Engineer's E-mail Address
Engineer's
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City I'I State i Zip Telephoned
CONTRACTOR'S NAME/COMPANY Lic No. dad jClass
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ors E mail Address
Contractor's Address �ontrac
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City t y � State Zip _ d e�.lS� _��, Telephone (1"'R��ll-W3 2"150-11-3l'lV
SETBACKS REAR SETBACKS FRONT PERMIT NO. !�•S/
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. - Q�� ..
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USE ZONE C DEVELOPMENT NO PLAN CHECK FEES $ y
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