HomeMy WebLinkAboutX2021-2574 - Permit ApplicationI_Print Form Worksheet for Combo Building & Solar Permit Application @140
F_Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Building F_-Grading- -Drainage -(-Flee (-Mech j`-Plum cuvdcut cued -rill
Project Address (Not mailing address) F_ Flood r Fire F_ Liq F_ Landslide FN/A Floor Suite No
2-10 T ABTA V'sTI-i- fl)c
Description of Work
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Use Const Type vPj
F W 17--T/,tGJC0 DU
#Stories #Units (if Res)
1 �
l
Valuation $'
New/Add SFF Remodel SF�
Garage/New/Add
Material/Labor / ��U
OWNER'S NAME Last �� Y E S
First i OVA
Owner's Address
Owner's E-mail Address
Z9a- &T/4 o5TIA pt.
City State F Zip F— Telephone
APPLICANT'S NAME Last 01 C7
First < �}
Applicant's Address
Applicant's E-mail Address
35y_,� CLWfM06-,4VfE
i0(4
City IDNi, 15etfcH State /-
Zip f Qg0g Telephone 3z 3' - (SSLt iJ
ARCHITECT/DESIGNER'S NAME Last
First Lic. No.
Architect/Designers Address
Architect/Designer's E-mail Address
City State �-
Zip F Telephoned
ENGINEER'S NAME Last Cj (�/1 (j FirstF[—)TN) F L lv tic No. Mi c 6 z
Engineers Address
Engineer's E-mail Address
5 3� 5,74- X I- CJ W kV
City L {j f u r v-T f�_ State I L /
Zip T 171-I Lf Telephone G Z- o - � 61 -- z,5— C)
CONTRACTOR'S NAME/COMPANY
Lic. NoT Class[
Contractors Address
Contractor's E-mail Address
City State F_
Zip F Telephone��
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SETBACKS REAR I Z. Z 01 / SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT LPLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $