HomeMy WebLinkAboutX2021-1116 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Applicati n/
City of Newport Beach - Building Division �tO
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Project Address(Not addd-ress) F_ Flood r Fire r Liq F- Landslide rN/A Floor Suite No
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Description of Work
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Material/Labo/
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OWNER'S NAME Last ' L _ First s
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Owner's Address Owner's E-mail Address-
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City � State Zip Telephone L/ 77.,?,79�
APPLICANT'S NAME Last , lrL First P
Applicant's Address Applicant's E-mail Address
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City fv dQ 44 State C- Zip Telephone �I
ARCHITECT/DESIGNER'S NAME Last t� First Lic. No. F
Architect/Designees Address Architect/Designer's E-mail Address
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City G is / 1 Q5 State G� Zip �3 Telephone;?
ENGINEER'S NAME Last J / ' V Fir/st D5Lic. No.
Engineer's Address Engineers E-mail Address
City State F"/I— Zip 9T6 ' Telephone
TR COR'S NAME/COMPANY (7 / � � c / Lic. No. 6 p`lC (I S'f Class �—
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Contractor's Address Con ractor's E-mail Address
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'lty lUe&j State Zip Telephon
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SACKS REAR SETBACKS FRONT PERMIT NO.
4CKS LEFT SETBACKS RIGHT PLAN CHECK NO.
)NE DEVELOPMENT NO PLAN CHECK FEES $
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