HomeMy WebLinkAboutX2021-1799 - Permit Application (2)Print Form Worksheet for Combo Buiiding r olar Permit Application
Comm'1 ❑Residential City of Newport Beach - Building Division 6 ''
NOTE: PLAN CHECK FEES: DUE AT TIME OF SUBMITTAL
Building I jiGrading
❑DrainageAElec ech
APlum cuvdCut 1-7] cuvdFill
177
Project Address (Not mailing address) ❑ Flood
❑ Fire ❑ Liq ❑ Landslide ❑N/A Floor Suite No
Des9fiption of Work
Use K17Const Type
# Storie # Units (if Res)
K
et v
?cal < Auti( Dd1P
New/AddSF
'Wluation S
Remodel SF Garage/New/Add _j Material/Labor
OWNER'S NAME
Last �7Z
FirstL
Owner's Address
Owner's E-mail Address
'"r ,
City
State
Zip _ Telephone V-3;7
APPLICANT'S NAME
Last
J First
Applicant's Address
Applicant's E-mail Address
City
_ State F77
Zip Telephone
ARCHITECT/DESIGNER'S NAME ' Last- First « , Lic. No. l ®c3
Architect/Designer's Address
Architect/Designer's E-mail Address
r_
a
9
City
L._ State
_-7
Zip Telephone •'�
ENGINEER'S NAME
Lastate'
Firsf� Lic. No.
Engineer's Address
A
Engineer's E-mail Address
I
City
State J�
Zip �`�.. Telephoned —7j
CONTRACTOR'S NAME/COMPANY Z�®4 Lic. No.j 107 Classwi
Contractor's Address
Contractor's E-mail Address Ovl a,�D ila : s
City
StateZip�`p_
Telephone.
SETBACKS REAR
SETBACKS FRONT
PERMIT NO.
-. SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK: NO.
' USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $