HomeMy WebLinkAboutX2021-1542 - Permit ApplicationPrint Form Worksheet for Combo Suilding & Solar Permit Application
City of Newport Beach - Building Division
r Comm'I F Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Proiect Address (N9 mailing address) r— Flood Fire f— Liq [- Landslide rN/A Floor
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New/Add SF
OWNER'S NAME
Owners Address
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Last I -pp(., f 4- 5
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First I _ E_t{'trt,
Owner's E-mail Address
Suite No
Use iu ConstType
# /oriesF—1 # Units (if Res)
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Valuation $
Material/Labor V
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APPLICANT'S NAME Last I (JnM A L
Applicant's Address �G
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City i::_t> State CA
ARCHITECT/DESIGNER'S NAME Lastl ���5�4�e-t,
Architect/Designer's Address
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First I [ " l
Applicant's E-mail Address
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Zip j0 Telephone 1tC r4y'.1 r3
First �(k b rt.Lic. No. �—
Architect/Designer's E-mail Address
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ENGINEER'S NAME Last '= S (�'.,p� ►,. .ij
rr Z First; I 1 ` F"'D` a� Lic. No.
Engineer's Address EEngineer's E-mail Address &W kAti �t-
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City ����i-C £ � State G � Zip F_ TelephoneFl V1 ..lyil _ 17
CONTRACTOR'S NAME/COMPANY , a 5 Z a g t S Lic No. �— Class
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Contractor's Address Contractor's E-mail Address
City �nv�r State Ct Zip i•Zlol� Telephone �bto` S63 ~�Z9 3- �
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $ � 1