HomeMy WebLinkAboutX2021-1645 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application ON
Comm I � Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) F_ Flood I"r Fire iq f- Landslide rN/A Floor Suite No
Description of Work
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# Stories1 # Units (if Res)F
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Valuation
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Gara e Add SIF Remodel SF Z �C -1 F_ a/New/Add
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Material/Labor I r
OWNER'S NAME Last C Cv First '/rJ"
Owner's Address Owner's E-mail Address
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City a �a� :, State �-n' Zip q i p r t Telephoners _, r
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APPLICANT'S NAME Last 7 yVt l y't�— First �7, cpNSU1-T
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Applicant's Address Applicant's E-mail Address
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City I t -I State �� Zip JZ b3 Telephone 03 /
ARCHITECT/DE SIGN ER'SNAME �J
Last S rn l� First 3Tom, 4 Lic. No. 5C
Architect/Designer's Address ArchitectlDesigner's E-mail Address
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City I-- _ State F Zip I Telephone (v- '(,'�z
ENGINEER'S NAME Last Zo� ref First) Lic No. + 4 -Cj
Engineer's Address Engineer's E-mail Address
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City j v 5� State f Zip 9 Z-7 TelephoreF' T
CONTRACTOR'S NAME/COMPANY ; 2 Lic No. ^II b 1�0 Class
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Contractor's Address Co� 'I d ss
City State �— Zip F Telephoned
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SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $