HomeMy WebLinkAboutX2021-2925 - Permit Application_P,inIFom__j Wor eet for Combo Building & Solar Permit Application
Comm'I F_ Residential O City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) Flood r Fiq rLandiROq �N/A Floor Suite No
Description of Work
Use <, stType
Stories #Units (if Res)F
Valuation $
Material/Labor F %j (J'
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New/Add SF � Remodel SF `3 �j Garage/New/Add
OWNER'S NAME Last 6-r First lQ i J f
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Owner's Address Owner's E-mail Address
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City State C, ZipF- L
2-6� 3 Telephone
APPLICANT'S NAME Last G���(S First F
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Applicant's Address Applicant's E-mail Address
City State L Zip ZG�L Telephone 0� I -
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State F Zip F_ Telephoned
ENGINEER'S NAME Last r L) (-N � r / First � e � Lic. No. Z'jr j
rJEngineer's
Address Engineer's E-mail Address
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City State Zip I ho
CONTRACTOR'S NAME/COMPANY Lic. No. n / Class 7
Contractor's Address Contractor's E-mail Address
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City ��L ,� State ;x Zip <x�,�;F Telephone,!'JC
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SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $ ( ,