HomeMy WebLinkAboutX2021-3365 - Permit ApplicationF.nntForm 1(vorksheet for Combo Building & Solar Permit Application o 0
City of Newport Beach - Building Division 2 ®2(' 3 3 °
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Comm', Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not (mailing address) 1- Flood [: Fire �, Liq < Landslide �N/A Floor Suite No
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Description of Work
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Valuation $
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OWNER'SNAME Last i�rEi _. _--.-- -
Owner's E-mail Address
Owner's Address
State 1 Zip 2� b 3 Telephone
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APPLICANT'S NAME Last��r4v}T-F"i
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ARCHITECT/DESIGNER'S NAME 'BGa✓ (5r✓L -
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Telephone
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First Lic. NoF
ENGINEER'S NAME Last --_ --'
Engineers E-mail Address
Engineer's Address
- State Zip
City
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CONTRACTOR'S NAME/COMPANY 1`i� � rat l& all, I
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Contractor's E-mail Address
Contractors AddressL o r x
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city State Telephone .
SETBACKS REAR �_ SETBACKS FRONT
PERMIT N0. X Z�Z i - 3365
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK N0.
nonAFNT NO
PLAN CHECK FEES $
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