HomeMy WebLinkAboutX2021-2273 - Permit Application (2)I ' �/ l r /►IM
Print Form Worksheet for Combo Building & Solar. Permit Application ON
Comm'I ❑ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
(Building ❑Grading Drainage Elec nMech [j Plum cuvdCut F_ I Cu YdFill F
Project Address (Not mailing address) ❑ Flood ❑ Fire F-1 Liq❑Landslide ❑N/A Floor Suite No
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Description of Work Use Const Type
#Storiesl� # Units (if Res)L J
Valuation
New/AddSF�� Remodel SF�� Garage/New/Add) Material/Labor
OWNER'S NAME Last __% �j �N (���' First
Owner's Address Owner's E-mail Address
H,I-I4d (. L/ jig
City L'"T-rVWr/—�� State
�Zip ✓ - Telephone '�,Jw
APPLICANT'S NAME LastC►/'T'f First
Applicant's Address Applicant's LE -mail Address
1 -.ori, Lf,y'
City �1 y(/dj- State �� Zip Telephone'3D'
ARCHITECTlDESIGNER'SNAME Last I Firs[ ) G . Lic No. �!e"
Architect/Designer's Address ArchitectlDesignees E-mail Address
City f% 4.1
Par � /'�t = G ' C � TelephoneNT ' 9 q ���_ �i
-- - n— l 1 7 L7 _� State _ � Zip . , _ (-� 7 44
city —
ENGINEER'S NAME Last First E Lic. No.
Engineer's Address Engineer's E-mail Address
I
City_ _ __- -- State Zip—i Telephone 1
CONTRACTOR'S NAME/COMPANY Lic. No, Class
Contractor's Address - - Contractor's E-mail Address
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City State Zip C Telephone—j
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SETBACKS REAR SETBACKS FRONT PERMIT NO. r(-�p�I ✓ �� l
SETBACKS LEFT - SETBACKS RIGHT - PLAN CHECK NO. TO
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $