HomeMy WebLinkAboutX2021-2638 - Permit Applicationy
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Print Form Worksheet for Combo Building & Solar Permit Application O
[- Comm'I Residential City of Newport Beach -Building Division 11�1 L ' -
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL 1/ ,+'�
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Project Address (Not mailing address) [- Flood
[- Fire [- Liq [- Landslide [-N/A Floor Suite No
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Description of Work
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# Stories? # Units (if Res)[—
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Material/Labor
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OWNER'S NAME Last GG-ti +'yLLt_�
First ,T'c=G
Owner's Address
Owner's E-mail Address
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APPLICANT'S NAME Last r_----
First
Applicant's Address
Applicant's E-mail Address
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Zip -ZL,>y Telephone q�'� Sc11 `) 1L
ARCHITECT/DESIGNER'S NAME Last xGl 1,1=Cz
First /cvL Lic.No.��
Architect/Designer's Address
Architect/Designer's E-mail Address
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ENGINEER'S NAME �' , Last ���
First I�i%lry �i Lic. No. -432-b!5-
Engineer's Address
Engineer's E-mail Address
City �— State F_
Zip F_ TelephoneF_
CONTRACTOR'S NAME/COMPANY
Lic No. F Class F
Contractor's Address 1
Contractor's E-mail Address
City State
Zip Telephone��
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $