HomeMy WebLinkAboutPV2021-002 - Permit Application�- EF of<Form',<< Wo, eet for Combo Building & Solar Permit Application
F Comm9 Residential City of Newport Beach - Building Division FV 7-c);? 1 Ov7
//// NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
[Building [-Grading )_�rainage [,Elec [Meth r7,Plu Cuvdcut , CuvdFill 17,
Project Address (Not mailing address) C Flood [7 Fire ! LigPP a rN/A Floor Suite No
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Description of Work LQ i t J �" tfqA UUsye ®ConstType
# oriUnits (if Res)I
Valuation S I
New/AddSF� RemodelSF�—; Garage/New/Add , Material/Labor r.,li) �A
OWNER'SNAME Last
First
Owner's Address Owner's E-mail Address
city &a Ck,State Zip c 2- c, Telephone 3� , SI
APPLICANT'S NAME Last I y} First I_tbri7e� 0�
Applicant's Address Applicant's E-mail Address
CitySY- State Zip 12(��� Telephone
— I
ARCHITECT/DESIGNER'S NAME Last First
Lic. No.
Architect/Designees Address Architect/Designer's E-mail Address
City State Zip Telephoner
ENGINEER'S NAME Last First Lic No y
_.._._
Engineer's Address Engineer's E-mail s
City I State Zip Telephoned',
CONTRACTOR'S NAME/COMPANY Lic. No. KIsn Class FT6
Contractor's Address V Contractor's E-mail Address
Telephone VAS,
City State Zip �L� l� Telephone �, sc_T 1o�
SETBACKS REAR
SETBACKS LEFT
USE ZONE
SETBACKS FRONT
SETBACKS RIGHT
DEVELOPMENT NO
PERMIT NO. A 20 2-(`
PLAN CHECK N0.
PLAN CHECK FEES $