HomeMy WebLinkAboutX2021-2304 - Permit ApplicationPrint Form
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Worksheet for Combo Building &Solar Permit Application
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City of Newport Beach - Budding Division p 111— " by
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBM TTAL
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Project Address (Not mailing address) C Floo�dy F- Fire Liq F_ Landslide rN/A Floor Suite No
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Description of Work r J
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# Stories[— # Units (if Res)'
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Valuations 4� a(n�fjJ
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OWNER'S Last 71' v First
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Owner's Address Owner's E-mail Address
City nr (It, ,/��'1/� .�� State Zipr Teleph e[7
APPLICANT'S NAME Last fl rl G. � - 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.
Architect/Designer's Address Architect/Designer's E-mail Address
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City L kq VU`s" !Gl-V�`' State Zip 2 5 Telephone �LI.�, 32z _�� �
ENGINEER'S NAME Last i 6 ?57 First (� Lic. No.�—
Engineer's Address Engineer's E-mail Address
City I z2m,' r-' 7, State' Zip ` aID 1 Telephone `I 14, �b { q„ L ) v-1
CONTRACTOR'S NAME/COMPANY 7� Lic. No. Class
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SETBACKS REAR SETBACKS FRONT PERMIT NO. 2Ci7 Z,
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO. PLAN CHECK FEES $
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