HomeMy WebLinkAboutX2021-3382 - Permit Application�Print Form Worksheet for Combo Buildin &Solar Permit A lication@06svtz
- ----- -- 9 ppComm'I Residential City of Newport Beach -Buildin Divisio�}QQ�NOTE: PLAN CHECK FEES DUE AT TIM BMA�r�ff� IPo,
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Project Address (Not mailing address) C Flood ( Fire and Suite No
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Description of Work
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'2XISC<�L APC—s
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# Stories # Units (if Res)s
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Valuation $
New/Add SFF-- Remodel SF ld0 U Garage/New/Add F
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Material/Labor
OWNER'S NAME Last L,f � (�
First F�UC vL _ _
Owner's Address
Owner's E-mail Address
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City ..._._�t v✓ hf __ fLt--' State FTA
Zip F Telephone
APPLICANT'S NAME Last First
Applicant's Address
Applicant's E-mail Address
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City , ,,A State
Zip 7 Telephone �[a�) (Z-3��q
ARCHITECT/DESIGNER'S NAME Last
Wh
S'rtiJ(i _-- Lic. No.
First Z� 0
Architect/Designer's Address
Architect/Designees E-mail Address
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_-_. _ _�i.-_—_(__ .____ -
City State—
Zip �,177/�� Telephone �[oy°
ENGINEER'S NAME Last
First Lic, No.s
Engineer's Address
Engineers E-mail Address
City State F__
Zip F— Telephoned
CONTRACTOR'S NAME/COMPANY
Lic. No. F-- ClassF—
Contractor's Address
Contractors E-mail Address
City I State F—
Zip F Telephoned®
SETBACKS REAR SETBACKS FRONT
PERMIT NO. % 20 Z ( - 3 3,S Z
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. Z`ly 7-ZOZ 1
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $