HomeMy WebLinkAboutX2021-2752 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Applicatioa
City of Newport Beach - Building Division�A(��� m
VComm'I sidential nlnTP vi AN] r.NF:rtcFFFR n[IF ATTIME OF SUBMITTAL
F�lding F- Grading _-Drainage F- Elec r Mech r Plum Cu ydcutF_ Cu Yd Fill
Project Address (Not mailing address) r- Flood ,F_ Fire r" Liq r Landslide rN/A Floor Suite No
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Description of Work 1V16Z P
Use(, Const Type
# Stories�� # Units (if Res)
10Gep/V4- �� AgAAenC�v ��° �� ��
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AN/J (� ill L�NP S %�i / l,�c�io lam/ 3 deyS/C-AP%7dv s
Valuation$
Material/Labor f�f/
New/Add SFF F. Garage/New/Add I
OWNER'S NAME Last ��L�/�(/� (gyp First--
Owners Address ; Owner's E-mail Address
City F_— � State �_—._...Zlp .—._..—. .Telephone -..—_.-._.--
APPLICANT'S NAME LastFirst
Applicant's, Address Applicant's E-mail Address
Telephone?
City _ 0A fcSbAOUy State r _..-_. Zip 2 2 �
ARCHITECT/DESIGNER'S NAME Last / N/ /Y�/ First/?-AVOY Lic. N -�� �
Architect/Designer's Address Architect/Designer's E-mail Address
----
City State ip f Telephone_
ENGINEER'S NAME Last First(_.-. -__-_—.-.._ Lic NoT - — —'
Engineer's Address - Engineer's E-mail Address
City State r_-_...-- Zip F.—._..-..-__., Telephoner_..--_.___.--
NAME/COMPANY Lilc.No. 15 —/q Class
CONTRACTOR'S
Contractor's Address Contractors E-mail Address
City '.. State (---- Zip Telephone— 1-.,
SETBACKS REAR SETBACKS FRONT PERMIT NO.
PLAN CHECK NO. ��
SETBACKS LEFT SETBACKS RIGHT