HomeMy WebLinkAboutX2021-0998 - Permit Application (2)x 2oz��p
Printl o�m Worksheet for Combo Building & Solar Permit Application -r r
F- Comm'I j- Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F -Building F_ Grading FiDrainage F.7, Elec rj Mech r Plum Cu yd cut F__ -7l Cu Yd Fill
Address (Not mailing address) L-1 Flood Fire r Liq Landslide _N/A Floor Suite No
in of Work Use jqtA' Const Type F
New/Add SF1 II Remodel SF/Add I _
OWNER'S NAME
Owner's Address
City I-/Z� , 1 -/Zo L State
# Stories # Units (if Res)
Valuation�0„ 1
Material/Labor �•.!
Owner's E-mail Address
Zip991 �/v, Telephone
APPLICANT'S NAME Last I `� Firs
Applicant's Address Applicant's E-mail Address
City State Zip Telephon '71TI g!y'+3..,Cj'/a
ARCHITECT/DESIGNER'S NAME Last First I I Lic. No.
Architect/Designer's Address
City State
Architect/Designer's E-mail Address
Zip —� TelephoneF
ENGINEER'S NAME Last First F Lic. No.1
Engineer's Address
City State F
Engineer's E-mail Address
Zip F_ Telephone
CONTRACTOR'S NAME/COMPANY/ /iGfnf� Lic. No. G-�1194ro.7 Class.
Contractor's Address
1;9
_.���+'1vs�h�o�e1 r7
city/G/ �i State F?,;.
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
Contr�acJtor's E-mail Address/
Zti (0/J'I9_ 103.GPo.t
zip ._�aG, Telephone
PERMIT NO. l\ W ILA 0,111S
PLAN CHECK NO. NO- - Vy t4
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $