HomeMy WebLinkAboutX2021-1881 - Permit Application (2)Print Fore,,,( [j Worksheet for Combo Building & Solar Permit Application �6WPoR.
omm'I r Residential City of Newport Beach -Building Division XX02 6�i
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMI'fTALo� I I c4 0
Building [ Grading F -Drainage r541ec Tech plum Cu Yd Cut Cu Yd Fill
-
Project Address (Not mailing address) Flood Fire Liq r LandslideN/A Fipor Suite No
Description of Work
Use I Const Type )
14
# StoriesF1_0 #Units(if Res)
Valuation $ 3, �� 00d
Material/Labor
New/Add SF Remodel SF � Garage/New/Add �—
—
OWNER'S NAMEm�jj /n�
Last 130-HAdr -- First
Owner's Address Owner's E-mail Address
-�0-- - -Fl. Go r--- --- -= - ---- -
City - -TFi State FTT Zip �J�Telephone �-I a-- q
APPLICANT'S NAME Last V� Firrst'C e
-._�-�1-`s — ---------------------
--- ---- ----...,
Applicant's Address Applicant' E-mail Address
SYJ
` /aTelephonem4=1
City State ' Zip (<
ARCHITECT/DESIGNER'S NAME Last �Mo First[Lic. No. n
Architect/Designer's Address Vq Ix�v t`44-Architect/Designer's E-mail Address
] I- n S
Cityc �h State �� Zip - - - -- Telephone
7
ENGINEER'S NAME Last �� ���\ First[ Lic. No.
Engineer's Address Engineer's E-mail Address
(� jp%)
city State Zi I t t r t/ Tele honeFT G 51167 0i 3(
CONTRACTOR'S NAME/COMPANY Lic. No. class
4a�3o/LL
Contractor's Address Contractor's E-mail Address BTsna�t�t6 7G
—
-' -
City State Zip F-- Telephoned
SETBACKS REAR SETBACKS FRONT PERMIT NO. X 20U�l a I
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $