HomeMy WebLinkAboutX2021-3145 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application a4�Eb�ae
F_ Comm'I residential City of Newport Beach - Building Division o
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL ��-.oar'
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Project Address (Not mailing address) (- Flood F Fire F Liq F_ Landslide FN/A Floor Suite No
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Description of Work
Use l I" /( ConstType
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# Stories #Units (if Res) L
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Material/LaborCoLrb
New/Add SFr Remodel SF Q Garage/New/Add
OWNER'S NAME Last , t�1VV4LaVL First
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Owner's AddressOwner's E-mail Address
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APPLICANT'S NAME Last .1� I��a Fyn iJGFirst q
Applicant's Address Applicant's E-mail Address
Zi Tele hone
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ARCHITECT/DESIGNER'S NAME Last � First �� Lie No.
Architect/Designer's Address Architect/Designer's E-mail Address
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City State F_Zip �� Telephonel(o�
ENGINEER'S NAME Last lj lr,P'\gy First tll�V'4ilc._ Lic.No.F
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Engineer's Address Engineer's E-mail Address
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City I C) ra,i.at e_ State r Zip j6(; Telephone ; $ ut - 61(G��
CONTRACTOR'S NAME/COMPANY Lie No. F— ClassF
Contractor's Address Contractor's E-mail Address
City State F_ Zip �— Telephone W2,\ . jo �-) iz
SETBACKS REAR SETBACKS FRONT PERMIT NO. 32 j 3) .J
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK N
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $ �i