HomeMy WebLinkAboutX2021-2694 - Permit Application (2)1U;l L1
Print FormWorksheet for Combo Building & Solar Permit Application oF��`°
F- Comm'I F-" Residential City of Newport Beach - Building Division o
NOTE: PLAN CHECK FEES DUE ATTIMEOF SUBMITTAL<.oa�'
F -Building F_ Grading rDrainage F-Elec F_Mech F- Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) _ Flood r Fire r"- Liiq f- Landslide F_N/A Floor Suite No
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of Work
Description of
Use F—Const Type F
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# Stories #Units (if Res)
New/Add SFF—Remodel SF U4 Garage/New/Add
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Valuation a
Material/Labor
OWNER'S NAME-- ^
Last v,Gifl�+..-�-9 _.._ First
Owner's Address Owner's E-mail Address
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.._Telephone
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APPLICANT'S NAME Last First ._�'; Cis:
Applicant's Address Applicant's E-mail Address
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City 1<j ,,c, N State Cell Zip Telephone wl L11 � 5' 2_I 1
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ARCHITECT/DESIGNER'S NAME Last First —��
Lic No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State F Zip 1 Telephone-
ENGINEER'S NAME Last �•--- First F_W Lic. No.F.J
Engineer's Address Engineer's E-mail Address
City � State F_ Zip F— TelePhoneF-'—
CONTRACTOR'S NAME/COMPANY ja't + -r». ; y . t i- ;r LIC. No. o Class St C; C,
Contractor's Address ” Contractor's E-mail Address
City ���,v f-\ State F777 .Zip c,C y,_ i Telephone t ks'e'; ;. ? �j1 r
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SETBACKS REAR SETBACKS FRONT PERMIT N0.
SETBACKS LEFT SETBACKS RIGHT . PLAN CHECK NO. -,
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $