HomeMy WebLinkAboutX2021-1691 - Permit ApplicationPrint Form_ Worksheet for Combo Building & Solar Permit Application a EWE"'a
j— Comm'I V Residential City of Newport Beach - Building Division a
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL �„oa•'
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Project Address (Not mailing address) F_ Flood
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Description of Work
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# StonesFT # Units (if Res)[
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Valuation $
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OWNER'S NAME Last /� K,,q-TA/gY
First
Owner's Address
Owner's E-mail Address
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City c`7>1') State /;
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Zip'� / 1 Telephone) 7
APPLICANT'S NAME Last ,f,��/ c= ��
First
Applicant's Address
Applicant's E-mail Address
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Zip �� L 4% "ZS Telephone 'jar-�. s v 7rr-
ARCHITECT/DESIGNER'S NAME ��
Last � j L. Cj'�
First ��_ r (' Lic No. t, - 5 ,-
ArchitecUDesigners Address
Architect/Designer's E-mail Address
City � � State �
Zip [ Telephoned
ENGINEER'S NAME Last I 01,2_15'r j
First p (-, L. ` Lic. No. c 2_C'_-C-"
Engineer's Address
Engineer's E-mail Address
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City S?AN A Ar�A State /'A
Zip TelephoneF
CONTRACTOR'S NAME/COMPANY —r .�
Lic. No. I Class F
Contractor's Address
Contractor's E-mail Address
City State F
Zip r Telephoned
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SETBACKS REAR 10 SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
l.' PLAN CHECK NO.
USE ZONE `�.-� DEVELOPMENT NO
PLAN CHECK FEES s _ (�