HomeMy WebLinkAboutPV2021-103 - Permit ApplicationPrint Form j (�Q�/�, Worksheet for Combo Building &Solar Permit ,pplicati�
F_Comm'I YReside � l City of Newport Beach - Building Division (0 ? 6
,NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
/4uilding F Grading rDrainage FElec r, Mech F-Plum Cu Yd Cut F Cu Yd Fill F
Project Address (Not mailing address) F! Flood F_Fire r Liq F_Landslide FIN/A Floor Suite No
Description of Work P� pU I 96'h' 9 1,ia FT
Use F— ConstType 'U-0
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,� q ,, #Stories', #Units (if Res)'
P'940501 lli'W �P�(N&r I50��r'�W 9&V00N13(�inV6
Valuation $
New/Add SF Remodel SF F Garage/New/Add Material/Lab4olZ
OWNER'S NAME Last �� First _ O M
Owner's Address Owner's E-mail Address
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City State Zip Telephone,
APPLICANT'S NAME Last /" First I maw
Applicant's Address Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last i�� First G g Z
' " Lic. No.
Architect/Designer's Address Architect/Designer's -mail Address
City State �, Zip [_ Telephoner
ENGINEER'S NAME Last First I Lic. No.6 7T2
Engineer's Address Engineer's E-mail Address
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City State F Zip Telephone C;� t 6 q� q - /,W Y
CONTRACTOR'S NAME/COMPANY fa p.1l Earth pr� G � � � Lic. No. � iq%o I Class C —t�
Contractor's Address t/ l 11 v 1 WContractor's E-mail Address
61`9 W ItSha, Ave,rote _q&) q6q
City n State Zip Telephone
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
PERMIT NO. — (0-3
PLAN CHECK NO. �a �j L� Z-07.4
PLAN CHECK FEES $