HomeMy WebLinkAboutX2021-2519 - Permit ApplicationRrint FormWorksheet for Combo Building & Solar Permit Application O�EWPoRm
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esidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
wilding F_ Grading Drainage [Flet I-Mech {',plum CuYdCutF Cu Yd Fill
Project Address (Not mailing address) F_ Flood ri Fire r— Liq [—, Landslide FN/A Floor Suite No
Description of Work T_WAwl WNAMS
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1 J Use F— ConstType
NQ'W LA CANTINA 3IFDLD toDn E)(T 9loe PATI
Z u x � iY , # Stories #Units (if Res)
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New/Add SF Remodel SF F i
Valuation $
Garage/New/Add Material/Labor F5,
OWNER'S NAME Last U o L rEFirst
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Owner's Address
Owner's E-mail Address
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city NE�Po�L State r �
Zip 1,7( i Telephone L y _2�- 2173
APPLICANT'S NAME Last ✓� � a
First J Q kE
Applicant's Address
Applicant's E-mail Address
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City V�+�NSV _ State CA—
Zip I Telephone yl3,S� JqJ
ARCHITECT/DESIGNER'S NAME Last
First F — Lic. No. r—
Architect/Designer's Address
Architect/Designer's E-mail Address
City State
Zip Telephone
ENGINEER'S NAME Last r� (�
First �l E Lic. No. e 33 _q 0
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Engineer's Address
Engineer's E-mail Address
City e.yn,,Ill �NiC State _
Zip Telephoneff/1 _ 0035-Z'800
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CONTRACTOR'S NAME/COMPANY { ,
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� �Ln �y I Lic. No.
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� Cr2OV Z Class 15Contractorrss
Address
Contract'or's E-mail Address
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City 06r i � State U
Zip Z %N Telephone jj= 711
TBACKS REAR
ACKS LEFT
ONE
SETBACKS FRONT
SETBACKS RIGHT
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PERMIT M •2600 1 't5M
PLAN CHECK NO. ` t ' ` , 26
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