HomeMy WebLinkAboutX2021-2434 - Permit Application9' 'rWvt LA Wd (if
Worksheet for Combo Building & Solar Permit Application
esidential City of Newport Beach - Building Division
NOTE: "PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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ress (Not mailing address) ❑,Flood ❑'Fire ❑ Liq ❑ Landslide ❑N/A Floors Sul iteNo
Work / , W 1 L / Use � Const Type
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Owner
State Zip l
„�r�..,. ,.....� Last LdF
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Applicant's Address)'Applicant's
E-mail Address
City State
Zip, 4 Telephone
ARCHITECT/UE$IGNER'$ NAME Last,C ' First Lic. No.�
^i
ArchitecttDesign6?s Address
Architect/Designers E-mail Address
City
State]'
Zip
Telephone[
----------
ENGINEER'S NAME Last ' First Lic. No;
Engineer's Address
Engineer's E-mail Address
City State
Zip
Telephoned
CONTRACTOR'S NAME/COMPANY
Lic. No. �� Class
_
Contractor's Address
Contractor's E-mail Address
l7 2 T,
City
¢ State
Zip
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SETBACKS REAR SETBACKS FRONT
PERMIT NO. O
SETBACKS LEFT `: SETBACKS RIGHT
PLAN CHECK NO.
O '� •��
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $