HomeMy WebLinkAboutPV2021-265 - Permit Application (2)Print Form Worksheet for Combo Building & Solar Permit Application o49( a°°Ratt
F- Comm'I r Reside n a 21 S City of Newport Beach -Building Division (33 f� fjyl,,l. rS f
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL Lvm
[-Building [-'Grading [—Drainage r'Elec j—Mech [-Plum Cu Yd cut' Cu Yd Fill
Project Address (Not mailing address) [- Flood [- Fire r Liq [- Landslide F_N/A Floor Suite No
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Description of Work 9
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Use F— GonstType
# Stories #Units (if Res)
2 Z5 A" 6 0 F ) 2 cf
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Valuation $
Material/Labor �j00C�?
New/Add SFF Remodel SFF—Gara a/New/Add F—'
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OWNER'S NAME Last1yQa%e{ First JO"
Owner's Address Owner's E-mail Address
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City State C Zip Telephone L
Ne�PO{ t�tuc �i2G o,�-2-75-OZct
APPLICANT'S NAME Last�V/S First �M(� _
Applicant's Address Applicant's E-mail Addrless_
10-113 NC, At. -CA - ( V ° ba,n ro •v1d f rwS _evA s • Co uA
City L,...f1o, SQf11, .C. ---- �I. State - Zip 70 Telephone F
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ARCHITECT/DESIGNER'S NAME
Last � � First �` Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City � State �—, Zip F—I Telephone
ENGINEER'S NAME Last t First Lic. No.
Engineer's Address Engineer's E-mail Address
City � � State F_ Zip F_ Telephone—
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CONTRACTOR'S NAME/COMPANY I ` nI (C Lic. No. -7 15 Z Class WCia
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Contractor's Address Contractor's E-mail Address
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City State Zip G 70 Telephone o L
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SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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