HomeMy WebLinkAboutX2021-2942 - Permit Application (2)Print Form Worksheet for Combo Building & Solar Permit Application �q�"e
� City of Newport Beach - Building Division X %,nl •'L1 q Z
Comm'I✓Residential
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL `�<�.oa+''
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Project Address (Not mailing address) F_ Flood F_ Fire [- Liq r Landslide [N/A Floor Suite No
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Description of Work
Use F_ Const Type F_
# Stories #Units (if Res)
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Valuation $
Material/Labor
New/Add SFF -
Remodel SF Garage/New/Add r- ----- -',
OWNER'S NAME
Last g r t E( First /40,
Owner's Address
Owner's E-mail Address
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city ^r-VJpgcq &44q
_.. State _Gt Zip ii4 , TelephoneF—
APPLICANT'S NAME
Last WAro[, First I D4,/A-(
Applicant's Address
Applicant's E-mail Address
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City Nawfgtl �Xq
_ State C/a- 4 ..Zip. gz;6e Telephone ` -7 -T-9-2-11-1
ARCHITECT/DESIGNER'S NAME Last FirstF_
Lic. No.F_
Address
Architect/Designer's E-mail Address
City
State F_, Zip F_ Telephone
ENGINEER'S NAME
Last 'First F_' Lic No.F_
Engineer's Address
Engineer's E-mail Address
City
State Zip � Telephoned—
CONTRACTOR'S NAME/COMPANY Lic. No. PTT,3 Class Fz
Contractor's Address
Contractor's E-mail Address
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State FEj� Zip �XLC o Telephone lql 378 ay'i7
SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. 21 SLe
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $