HomeMy WebLinkAboutX2021-0847 - Permit Application (2)Punt Form W t for Combo Building Sr Solar Pe ml -t App! cation
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City of Newport Beach - Building Division a
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL �uaa�•�
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OWNER'S NAME Last K4V� ���17 First K
Owner's Address Owner's E-mail Address
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APPLICANT'S NAME Laast First
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Applicant's Address ��` �i( 7 Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME ,/,/gyp
Last s!�'G�f✓(v� First AS Lic. No. T— 7 174
Architect/Designees Address ArchitecUDesignees E-mail Address
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City � ��A/�. - State ZipFt7W/T Telephone ?:v9
ENGINEER'S NAME Nr� Last First F Lic. No.F—
Engineer's Address Engineer's E-mail Address
City State F Zip I Telephonel—
CONTRACTOR'S NAME/COMPANY OVIpI , VIZ4N _ ®, ` (��I •� / + , Lic No. �y� �$3 Class ['
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Contractor's Address Contractor's E-mail Address
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SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NOO..
USE ZONE DEVELOPMENT NO PLAN CHECK FEES°'$' ^`—'""'""'"`-"""•^•-.
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