HomeMy WebLinkAboutX2021-1991 - Permit Application (2)P,nnf Form ff i''Worksheet for Cambo Building & Solar Permit Application o eW°sae.
Comm I City of Newport Beach - Building Division �//�2 �2� I
r; Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL - o
,Building ❑Grading [;Drainage
❑Elec F_ Mech C7 Plum cu rd cut Cu Yd FIII �
Project Address (Not mailing
address) lood ❑ Fire Liq ❑ Landslide ❑N/A Floor Suite No
Ave
Description of Work
Use 17 Const Type
O Q1Y1p
_ # Stories # Units (if Res)s
Valuation $
New/Add SFRemodel SF i�(p— Gare/New/ Material/LaborF_
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OWNER'S NAME Last First
Owner's Address
Owner's E-mail Address
City
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State QQ ,, LL / --
Zip-LLl�IP Z Telephone Rei �: 1.Z_ ? z
APPLICANT'S NAME Last First
Applicant's Address
Applicant's E-mail Address
--P. o Box 11-32— ----- ----
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City - — n
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State /F.... Zip Telephone GjLtq'1f rJ '033 ' "o
ARCHITECT/DESIGNER'S NAME Last
�— First —Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State Zip [7— Telephoner
ENGINEER'S NAME LastFbii
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[h r -J First 17A'U Lic. No. >
Engineer's Address
Engineer's E-mail Address
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City
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State �CA ZiP 4j_. J �l- Telephone p yq 0' t
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CONTRACTOR'S NAME/COMPANY
Lic. No.
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Contractor's Address
r Contractor's E-mail Address
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City (} - , �_ -
State Zip Telephone
SETBACKS REAR SETBACKS FRONT L PERMIT NO.
SETBACKS LEFT : SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT g� ,. :: __ .. , PLAN CHECK FEES