HomeMy WebLinkAboutPV2021-183 - Permit ApplicationF- Comm'I
lii,rksheet for Combo Building & Solar Permit Application
�( City of Newport Beach -Building Division Y Y %A -I zs
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
wilding r', Grading _r -Drainage Elec F, Mechrl Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) F-, Flood j- Firer Liq F,, Landslide F_,N/A Floor Suite No
Description of Work U ct
Use Mconst Type �
/0 S 44A ' S ,I- ro # Stories , # Units (if R
New/Add SF� Remodel SFF—I Garage/New/Add
Applicant's Address
CityI Ce 4.^ �� 2�2` State �—
Applicant's E-mail Address
Zip P`Z Telephone f,1/f-3ZiC C
ARCHITECT/DESIGNER'S NAME Lasti First Lic. No.
i
Architect/Designer's Address
City— State F—'
Architect/Designer's E-mail Address
Zip Telephoned!
ENGINEER'S NAME Last �G 441 First [ Lic. No. E1 ,/& 3
Engineer's Address12-0
Z7 1®u.°�h
City �� /._l3. State ( �-
Engineer's E-mail Address
Zip l�tp�(e Telephone
CONTRACTOR'S NAME/COMPANY Q Lic No. FIRL9 '/Mass
Contractor's Address ✓
1,313 / ,:.cjtw�41 j
City&tt,State (fit
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT
USE ZONE
SETBACKS RIGHT
DEVELOPMENT NO
Contractor's E-mail Address
Zip '% v Telephone 4_�LS8-t-/P-3c)?j3
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEES $
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