HomeMy WebLinkAboutX2021-2912 - Permit Application„Print form ,i Worksheet for Combo Building &Solar Permit Application
F Comm'I rAesidential City of Newport Beach - Building Division Xm21- gal I 2
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building [ Grading Drainage F_ Elec
Project Address (Not mailing addrea
�Mech Plum cu yd cut
Flood F-, Fire F_ Liq [- Landslide
New/Add SFF__ RemodelSF1-r1r Garage/New/Add
OWNER'S NAME Last
Owner's Address
- Igy7 16siduard. crane
City
APPLICANT'S NAME Last
First
Owner's E-mail Address
State 1_L -- __--- Zip
Applicant's Address
_._.__ .....
City State F
First
Cu Yd Fill
rN/A Floor Suite No
F7-7
Use F Const Type
# StoriesF_ # Units (if Res)F
Valuation$
F
Material/LaborW�
Applicant's E-mail Address
.. - -- -
Zip [777777 Telephonel
ARCHITECT/DESIGNER'S NAME Last First I Lic. No. F—
Architect/Designer's Address
City State I
Architect/Designees E-mail Address
Zip [— Telephonel—
ENGINEER'S NAME Last 8/�den�x� First ar Lic. No. W1003
Engineer's Address
City tfW\ -.... State
Engineer's E-mail Address
- QQQ ..... - -- --
Zip Gi Telephone7IU.636-6100
CONTRACTOR'S NAME/COMPANY , l _ /�,n5 / .`A /Jv< Lic. No. � Class[
/t��( (,(j & (,Q '
Contractor's Address
City AVA I,znA StateFcA
SETBACKS REAR SETBACKS FRONT
Contractor's E-mail Address
Zip 7V Telephone 77y-„ 63�
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO �7� (il -� �5 1 PI AN CHF( -.K FFFC R