HomeMy WebLinkAboutX2021-2843 - Permit ApplicationPrint Forrn W rk5 eet for
fI Comm'I (J Residential NOTE:
Combo Building & Solar Permit Application
City of Newport Beach - Building Division
PLAN CHECK FEES DUE AT TIME OF SUBMITTAI
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Building Grading [,Drainage P`Wec 'Z7mech Plum Cuvdcut� CuvdFlnEI
Project Address (Not mailing address) Flood J--❑ [Fire Liq Landslide �N/AFl000�r,�111
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Description of Work
Use p�(�� onstType GPM
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# StoriesTi # Units (if Res)
Valuation 51.
Material/Labor k7
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New/Add SF�—Remodel SFF� Garage/New/Add
OWNER'S NAME Last i- First
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Owners Address Owner's E-mail Address
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City _ �T�,4/ State Zip y Telephone
APPLICANT'SNAME Last First
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Applicant's Address Applicant's E-mail Address
City State [ I Zip �(¢ (Z 7i Telephone Z___�j %�7 y0
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ARCHITECT/DESIGNER'S NAME , > �i
Last �]\�.17 First ._ P(�----i Lic. No- 4_7 Ll.s
ArchitecUDesigner's Address Architect/Designer's E-mail Address
my) �y� G�J State i -W-1 Zip Z6.6V Telephone Cp G
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ENGINEER'S NAME Last First No.
Engineer's Address Engineer's E-mat dress
City --_-._ -__ I State Zip �� TelePhone�l-------- -
CONTRACTOR'S NAME/COMPANY PrrrfH141_ Lic. No. A lk� 1 Class
Contractor's Address Contractor's E-mail Address
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City �� (' ,, StateI j Zip �C�S� Telephone.
SETBACKS REAR= SETBACKS FRONT PERMIT NO. Z' "
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO- I
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $