HomeMy WebLinkAboutX2021-1373 - Permit Application (2)Print Farm Worksheet for Combo Building & Solar Permit Alication no
City of Newport Beach - Building Division . 1r Comm'I 'v�iesidential NOTE: PLAN CHECK FEES DUE AT TIME OF SUB L ��
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Project Address (Not mailing address) C Flood F.— Fire f— Liq F_ Landslide FN/A Floor Suite No
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Description of Work
Use Const Type
# Stories # Units (if Res)s
Valuation
Material/Labor
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OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
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APPLICANT'S NAME Last ��J�L -.. -_ . _ -, First _ .. 6G ne7-
Applicant's Address Applicant's E-mail
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City V&AN,%6 r,4e,,�,r-_ State — Zip i�TelePhone
ARCHITECT/DESIGNER'S NAME LastTRU �U L.fJ First �!C!'�CJL_ff,S Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City StateZip Telephone
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ENGINEER'S NAME Last First --' Lic No.F—
Engineer's Address Engineer's E-mail Address
City - State— Zip Telephoned--
CONTRACTOR'S NAME/COMPANY � � 9644 Lic. No. 74y16CIpClass
Contractor's Address Contractor's E-mail Address
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City %e wGfib.,, %�rS�Fv State Zip r— Telephoner W
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SETBACKS REAR SETBACKS FRONT PERMIT NO. X Z-07-1 -- ) '3%
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. t Z I I — ZCrLL
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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