HomeMy WebLinkAboutS2021-0210 - Permit ApplicationPrint Form_ Worksheet for Combo Building & Solar Permit A licattion
Comm'I r- Residential City of Newport Beach - Building Divisio0 tiV� 0
NOTE: PLAN CHECK FEES DUE AT TIME OF SUB
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F—Building F.— Grading [—Drainage [Elec F'Mech F— Plum CuvdCut r CuvdFill F v
Project Address (Not mailing address) r Flood r Fire r iq F- Landslide 1 -N/A Floor Suite No
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Description of Work
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Valuation
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OWNER'S NAME Last �Cl f First i Zd CT \ v41C'�
Owner's Address Owner's E-mail Address
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State Zip — TelephoneF1 1� _7):v _,�77 `3
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APPLICANT'S NAME Last �/ ���\ First
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Applicant's Address Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last First Lic. No. F_.
Architect/Designer's Address Architect/Designer's E-mail Address
City State �— Zip F— Telephonel—
ENGINEER'S NAME Last First Lic. No.F—
Engineer's Address Engineer's E-mail Address
City State Zip �— Telephone
CONTRACTOR'S NAME/COMPANY// Lic. No. - lass D7j
Contractor's Address Contractor's E-mail Address 10 �1
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City C) �15C7 v C \� State Zip j Lj Telephone �� �Ci
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SETBACKS REAR /0 SETBACKS FRONT C Zi / PERMIT NO. X i t L`1 U 7
SETBACKS LEFT 1:7 SETBACKS RIGHT PLAN CHECK N0.
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USE ZONE DEVELOPMENT NO PLAN CHECK FEES $