HomeMy WebLinkAboutX2021-3074 - Permit ApplicationX1p21-
Print Form Worksheet for Combo Building & Solar Permit Application
` City of Newport Beach - Building Division
(� fomm'I [ idential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) [- Flood [- Fire F_ Liq Landslide F_N/A Floor Suite No
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Description of Work 1AD 2lx l
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OWNER'S NAME Last. 7111-(111f/e First
Owner's Address Owner's E-mail Address
City State F_ Zip F— TelephoneF_
APPLICANT'S NAME Last First IJ Jl y
Applicant's Address Applicant's E-mail Address
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City /i1�oA / 5 "A 10 State Zip / ?4_ [7 �.. Telephone.0.�0r�-
ARCHITECT/DESIGNER'S NAME/
Last %�//���lZ First �/41>(/,Q`/ Lic No. �-°Z`Z
Architect/Designer's Address Architect/Designer's E -mai Address
City State F Zip r Telephone
ENGINEER'S NAME Last First Lic. No.r-----__-_...-.—
Engineer's Address Engineer's E-mail Address
City _ State w Zip F— TelephoneF_
CONTRACTOR'S NAME/COMPANY Lic No.l 7U %9 3 Class
Contractor's Address Contractors E-mail Address 13T30062623
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City State F Zip F Telephone
SETBACKS REAR SETBACKS FRONT PERMIT N0. —�>U C (.!
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. 7--�
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $