HomeMy WebLinkAboutX2021-0965 - Permit ApplicationK. 202(-001nF,,
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Print Form Wol h t for Combo Building & Solar Permit Application Comm'I ( ResidentialCity of Newport Beach - Building Division)VOTE: PLAN CHECK FEES DUE AT TIME OFSHBMITTAI
rBuilding Grading F e r`Elec F_Mech F- Plum, cuvdCut rcuvdRIF
Project Address (Not mailing address) F Flood 17F' e, Li F- Landslide FVN/A Floor Suite No
Description of Work Us Const Type
# Storiesr— #Units (if Res)r�
New/Add SF Remodel SFr—
(alua,eial 5Garage/New/Add �- teial/L, bor�
OWNER'S NAME Last Vv , ZFirst`
... GiU.I. _...
Owner's Address Owner's E-mail Address
City 'tpilJ 1'�lpi State -- Zip 2r,� ' Telephone i L
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APPLICANT'S NAME;
Last V✓ y :� First
Applicant's Address Applicant's E-mail Address
City .State-- Zip Telephoner
ARCHITECT/DESIGNER'S NAME Last First-- Lic.No. r---'
Architect/Designer's Address Architect/Designer's E-mail Address is
city r— State J -.-_i Zip F--.-- Telephone��'
ENGINEER'S NAME Lastitt V ] First
,G X11 vLt_Gl LtNo °,
Engineer's Address Engineer's E-mail Address
city State �— Zip F-.-- Telephoner------
CONTRACTOR'S NAME/COMPANY Lic. No. F_ Class F_
Contractor's Address Contractor's E-mail Address
City r�... State r_ ZIP r-- Telephoner ----
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK N6.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $ @@