HomeMy WebLinkAboutX2021-1987 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permll Application ON
r- Comm'I Residential City of Newport Beach - Building Div'�)' 2� •�NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMI TA
Building r Grading f—Drainage f5ftlec r Mech 2Plum cu Yd cut Cu Yd Fill
Project Address (Not mailingl address) r Flood [_ Fire r Liq F' Landslide CN/A Floor Suite No
Description of Work
Use F—Const Type
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OWNER'S NAME Last First��%�
Owner's Address Owners E-mail Address =
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APPLICANT'S NAME Last I C t� - F aAx—� First
Applicant's Address - Applicant's -mail
�Ad`dress
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City ��v�i�� State �— Zip 9`41b. Telephones.
ARCHITECT/DESIGNER'S NAME Last First F --', Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State F -- Zip r----, Telephone---',
ENGINEER'S NAME Last First F—s Lic. No.
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Engineer's Address Engineer's E-mail Address
City '. State r-- Zip r Telephone F_
CONTRACTOR'S NAME/COMPANY Lic. No., , Class
Contractor's Addressrr Contractor's E-mail Address
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City \� State �— Zip L Telephone � V {}�()`'�
SETBACKS FRONT PERMIT NO. 061A, u
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SETBACKS REAR
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. M W
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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