HomeMy WebLinkAboutX2021-0264 - Permit ApplicationPrint EaMj Worksheet for Combo Building & Solar Permit Application �EWPo,,
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Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE
A7 TIME OF SUBM6 �' ®Z`
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Project Address (Not mailing address) I- Flood Fire I cuvdrm
j- Liq j- Landslide j -N/A Floor Suite No
Description of Work -- -
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-- �(V # StoriesF7 # Units (if Res)
New/AddSF�- RemodelSF-
Garage/New/Add Valuation $
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OWNER'S NAME Material/Labor
Last
Owner's Address _ First
p c �rc'y► Owner's E-mail Address
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City K-� State j� -_-f- 4.1�at
APPLICANT'S NAME
Zip I r Telephone-
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Last �/ -
lyx�Est {AiL First -� �n
Applicant's Address --
�- ( Applicant's E-mail Address
City
State�- Zip -C�S_�
Telephoner! -(4
ARCHITECT/DESIGNER'S NAME
Last
Architect/Designer's Address _ First
Lic. No.
Architect/Designer s E-mail Address
City
State �_ Zip Telephoner
- --
ENGINEER'S NAME I
Last
First Lic. No.�-
Engineer's Address _ -
Engineer's E-mail Address
-- I
City
State
Zip Tele phone��- -- I
I
CONTRACTOR'S NAME/COMPANY
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Contractor's Address /� Lk. No. gGiar a r� Class
�rb j- Contractor's E-mail Address Q r J�
City
State - Zip F�
Telephone _7 (l , f
SETBACKS REAR
SETBACKS FRONT
SETBACKS LEFT -�� PERMIT NO,
SETBACKS RIGHT
PLAN CHECK NO.