HomeMy WebLinkAboutX2021-2751 - Permit ApplicationPrint Form Worksheet for Combo Building &Solar Permit Application0611R
�Comm'I r esidential City of Newport Beach - Building Division L1- LIS',
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
uilding F_ Grading f --Drainage rElec F_Mech ["'Plum cuvdCutr cuvdFill F
Flood Fire Li Landslide F_N/A Floor Suite No
Project Address (Not mailing address) r � C q
Desc iption of Work A
UConst Type
f
# Stories # Units (if Res)r�
it 5
?AN . >
Valuation $
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New/Add SFF_- ego@ � //IITZ Garage/New/Add -
Material/Labor
OWNER'S NAME Last " ' N&First
Owner's Address Owners E-mail Address
City1-7 State r Zip I TelephoneF ---
APPLICANT'S NAME Last 1 7"A Y-- First .4
Applicant's Address Applicant's E-mail Address
ZOiv_ly A&Az-rvk AvgJ eA66ov$i'o0`�. Cosyr
City f�jA(��jPA EfiJ /LW State I Cid -... Zip �jr eo2 Telephone -W.- Z e)r-C'SG'Pi.
ARCH,ITTEECT/DESIGNER'S NAME Last I P/a-JiAtAl First Lic. N
Architect/Designer's Address Architect/Designer's E-mail Address
O� Agt,
City - Zip(----- Telephone��..
ENGINEER'S NAME Last First F-, Lic:No.r_-
Engineer's Address Engineer's E-mail Address
City r State F_. :Zij� TelephoneF_
CONTRACTOR'S NAME/COMPANY k Lic. No. RS6795 Classy
Contractor's Address Contractor's E-mail Address
City State w Zip.-- Telephoner----.------
1!
SETBACKS REAR SETBACKS FRONT PERMIT NO. -s
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.�!'`'-''y