HomeMy WebLinkAboutX2021-2889 - Permit ApplicationFPrint Form Worksheet for Combo Building & Solar Permit Application
Comm'1 Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Address (Not
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Description of Work
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Floor Suite No
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OWNER'S NAME Last B),
Owner's Address
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Use I—
ConstType r—
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Valuation$ nn
Material/Labor
Owner's E-mail Address
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City State F_
ZIP F— Telephoner ---
APPLICANT'S NAME
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Applicant's Address
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City State c q
ARCHITECT/DESIGNER'S NAME
Last
First
Applicant's E-mail Address
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ZIP 9 ZC 2 � Telephone q�
First
Architect/Designer's Address Architect/Designer's E-mail Address
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Lic. No. r---
ENGINEER'S NAME Last
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Engineers Address
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CONTRACTOR'S NAME/COMPANY ( 13y3
Contractor's Address
Lic. No. F—
Class
Contractor's E-mail Address
City I State F-- Zip F— Telephoned ---
SETBACKS REAR SETBACKS FRONT
PERMIT NO. X�p�t - �--5�`�
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.v�/.�
USE ZONE DEVELOPMENT NO vv 11
PLAN CHECK FEES $