HomeMy WebLinkAboutX2021-2273 - Permit ApplicationAi021- 223
Print Form Worksheet for Combo Building & Solar. Permit Application , EWPpRe
Comm'I ❑j Residential City of Newport Beach - Building Division �^
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL %<�.e.••' r
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Address
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Description of Work
address) ❑ Flood ❑ Fire j j Liq F) Landslide ❑N/A Floor Suite No
02- d P- PII �J
OWNER'S NAME Last
Owner's Address
City - V f 11% i' —� State 6
First
Use� ConstType F
# Stories # Units (If Res)n
Valuation
Material/Labor
`
New/AddSFRemodel SF J Garage/New/Add
OWNER'S NAME Last
Owner's Address
City - V f 11% i' —� State 6
First
Use� ConstType F
# Stories # Units (If Res)n
Valuation
Material/Labor
`
Owner's E-mail Address
Zip) Telephone q4 -17,-t4—
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APPLICANT'S NAME Last ��/��"l First L-
Applicant's Address ('—�-- Applicant's E-mail Address
City -_-_ CI y(A/ rI State L� Zip r '2. ,�y4�Telephone 72'--��:�__ � v
ARCHITECT/DESIGNER'S NAME Last L— —(, �i� First 1 1�. Lic. No. L/ f
Architect/Designer's Address f Architect/Designer's E-mail Address
city L— - -- F( i1n13Fi(ii State �� Zip qT6-C� Tele hone -j,- �,ej l"
ENGINEER'S NAME Last _ _ J First Lic. No.
Engineer's Address Engineer's E-mail Address
i
City State—I Zip �� Telephoned
CONTRACTOR'SNAMElCOMPANY- Lic.No.� �I Class
Contractor's Address - Contractor's E-mail Address
i
City State Zip
SETBACKS REAR
SETBACKS LEFT
USE ZONE
SETBACKS FRONT
SETBACKS RIGHT
DEVELOPMENT NO
PERMIT NO. MCIA ✓
PLAN CHECK NO.
PLAN CHECK FEES $