HomeMy WebLinkAboutX2021-2662 - Permit ApplicationizI -t ,-x
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Print Form Worksheet for Combo Building & Solar Permit Application
rnmrt I Residential City of Newport Beach - Building Division
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Project Address (Nov ` ng address) - Flood j" Firer Liq j` Landslide F Floor Suite No
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Description of Work �fti% Yom
Use6 Const Type
# Storiesr3 #Units (if Res)rY
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Valuation $ � R
Material/Cabo
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OWNER'S NAME Last ��c � � ' Firstd 1;k
Owner's Address Owner's E-mail Address
:Zip _ Telephone
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APPLICANT'S NAME Last / ��T First
Applicant's Address .Applicant's E-mail Address
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City State -_ Zip.�� _--_. Telephone '��9- ``��-- l�' '
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ARCHITEC DESIGNER'S AME Last First F --- - Lic No. �—
Architect/Designer's Address - Architect/Designer's E-mail Address
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City (---- State �— Zip F_ Telephoner---,---.--/—
First P%� Lic No. c 'f ° e>
ENGINEER'S NAME Last �1
Engineer's Address Engineer's E-mail Address
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city �--__,_..— ..State F_ Zip �! Telephoner.—_----.__.
CONTRACTOR'S NAME/COMPANY Lic. No. F. Class
Contractor's Address Contractor's E-mail Address
city/,/ yo—T State ��. ZiP 47 � Telephone `J 14 '� 7 �
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SETBACKS REAR SETBACKS FRONT � � PERMIT NO. l -D'
SETBACKS LEFT �� SETBACKS RIGHT PLAN CHECK NO. ? S3 ' Zy rte(
USE ZONE .- DEVELOPMENT NO PLAN CHECK FEES $