HomeMy WebLinkAboutX2021-2190 - Permit ApplicationPrint Form ;,I Worksheet for Combo Building &Solar Permit Aplication
r Comm'I r Residential City of Newport Beach - Building Division x2u��21�� n
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBM TTAL
FX,Building Grading 'Drainage rElec r, Mech r', Plum cu Yd cut F Cu Yd Fill
Project Address (Not mailing address) FXT Flood (Xx Fire FX_ Liq f; Landslide f�_<N/A FloorSuite No
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Description of Work
Use F Const Type Fq J
#Stories. #Units (if Res)[
valu l
1<1[ i e
„e.._ 4 13 0= K—ewto,o-ems
New/Add SF Remodel SF Garage/New/Add�
Y
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Mater al/Labor
OWNER'S NAME Last �Glrt c �ti Q
First
Owner's Address
Owner's E-mail Address
ar1-TW NV vK lfriL Co^
City N L w P G wz _ State
Zip cZ Z6 G� Telephone g/% �11,7J�/�27
APPLICANT'S NAME Last 0j,
First fw,
Applicant's Address
Applicant's E-mail Address
'.-, L-1 J 2rn.aaJ 2Cor.� STM4,, C_C r tori
City o5'T A, N'\e_5 i% State C'
Telephone
Zip 2�
ARCHITECT/DESIGNER'S NAME Last `F.1 la"er First�'� ,,,,Z Lic. No. 98�fJf'j
Architect/Designer's Address
ArchitecUDesigner's E-mail Address
176-7 !U�cv ro- w7
City /lam State
Zip Telephoned
ENGINEER'S NAME Last �—
First F Lic. No.
Engineer's Address
Engineer's E-mail Address
t0^-\ (2tArso, S.4 .-45-
City State F
Zip Telephone
CONTRACTOR'S NAME/COMPANY ek-a"e_
Lic. No. /)�pr/, ass
Contractor's Address
Contractor's E-mail Address
City State F
Zip [—� Telephone
SETBACKS REAR (0 SETBACKS FRONT Z U PERMIT NO.
SETBACKS LEFTSETBACKS RIGHT
�_ PLAN CHECK NO
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $