HomeMy WebLinkAboutX2021-2349 - Permit Application':Pnn Form ^• Vorksheet for- Corr b'o Building & Solar Permit Application o4�` °"e
City of Newport Beach -Building Division
Comm'I Residential o
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL �<
'Building F-1 Grading F -Drainage ❑Elec (--IMech F-iPlum cu rdcutF- - CuvdFill
Project Address (Not mailing address) CI Flood F_� Fire F -I Liq r Landslide ❑N/A Floor Suite No
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Description of Work
New/Add SFF�' Remodel SF Garage/New/Add l
OWNER'S NAME Last
First
Use __ 'Const Type
#5toyiesFT # Units (if Res)F
Valuation $ ul7 doo
Material/LaboyT
Owner's Address Owner's E-mail Address
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city i4 1r , g� - State Zip �_7_V-.� p Telephone ryry y
APPLICANT'S NAME Last
Applicant's Address
city � p �. ` State
ARCHITECT/DESIGNER'S NAME Last 1n Il
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Architect/Designer's Address
City - - State F
First
Applicant's E-mail Address
Wiz« ' ILC J& e -P. (.w•
Zip Telephone
First
Lic. No.
Architect/Designer's E-mail Address
Zip F Telephone[7—
ENGINEER'S NAME Last First Lic. No.�
Engineer's Address Engineer's E-mail Address
City State F Zip Telephonel—
CONTRACTOR'S NAME/COMPANY Lic. No. F Class
Contractor's Address Contractor's E-mail Address
City State F_- Zip Telephonel—
SETBACKS REAR
SETBACKSLEFT
SETBACKS FRONT
SETBACKS RIGHT
�i AItnI.
PERMIT NO.
PLAN CHECK NO.