HomeMy WebLinkAboutX2021-2499 - Permit ApplicationF_Pr_intFoFFn:j Worksheet for Combo Building & Solar Permit Application oc`o°R>e
Comm'I Residential
City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBM 1
j jBuilding F] Grading rDramage ITIEIec [7,Mech f7 Plum. Cu YdCut l CuYdFill n
Project Address (Not mailing adss) F-1 Flood n Fire� 7_1 Lig1 F Landslide ❑N/A Floor � Suite No
C4 Mrd�_
Description of Work
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Use p ( Const Typeoil �t�(
U-4 lYII -
# Stories I # Units (if Res)s
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Valuation a [
Material/Labor
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New/Add S Remodel 5F—� Garage/New/Add
OWNER'S NAME Last (f' �' /"' qst
Owner's Address Owner's E-mail Address
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City �f JV V� "[� _ J State L `�L Zip (1 Telephoned
APPLICANT'SNAME Last �� First Vjl7y J
Applicant's Address Applicant's E-mail Address
City state b Zip ).(0(27 Telephone ,, 2�- �r 1. �.7�>o
ARCHITECT/DESIGNER'S NAME jsI
Last ��� lJ,h First�Itr -_-I; Lic. No. G- cJs
Architect/Designer's Address Architect/Designer's E-mail Address
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City��yt/ (/T State �� Zip - Gi ZCj{j- ] Telephoned-
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ENGINEER'S NAME ._ - -_ -- — �—
Last First I ��� Lic. No. _ �I
7777
Engineer's Address Engineer's E-mail Address
City - - Statel Zip F7 Telephone
CONTRACTOR'S NAME/COMPANY ""� �� `;��, �j�irZ,M� Cr7 - Lic No. �� Class
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Contractor's Address Contractor's E-mail Address
City State Zip Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO. ROM in
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. 110nM
USE ZONE DEVELOPMENT NO PLAN ECK FEES $