HomeMy WebLinkAboutX2021-3074 - Permit Application (2)/,y X11021 -
Print Form Worksheet for Combo Building & Solar Permit Application " ' u?`p",
jr t omm'I �fidential City of Newport Beach -Building Division a
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL G<,oN!•
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Project Address (Not mailing address) F Flood/QF- Fire r2LLiiq F- Landslide CN/AI Floor Suite No
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Description of Work j> Zl)G l G%(J /Z
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Valuation DQ
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New/Add SF� el �'�j 't' � Garage/New/Add f —. --.---_
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OWNER'S NAME Last(/Oif/� First
Owner's Address Owner's E-mail Address
City State r.__ Zi ---- ___.
p -- Telephone
APPLICANT'S NAME Last ,"/:70A_),/ First /A
Applicant's Address Applicant's E-mail Address
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City ! /���N 1C�' iiAAC � State FA ZiP �Z/fJ � 2 Telephone G%t
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ARCHITECT/DESIGNER'S NAME Last /� j�� First �y41n/p t� Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State Zip F.-.------ Telephoner--_--------..
ENGINEER'S NAME Last First F_ Lic. No.F----_
Engineer's Address Engineer's E-mail Address
City State rV— Zip r---. Telephoned--.
CONTRACTOR'S NAME/COMPANY Lic. No. g56793 Classr—
Contractor's Address Contractors E-mail Address 3T30062623 '-3"Z'-
city State F Zip r------ Telephone[
SETBACKS REAR SETBACKS FRONT PERMIT NO. iw v t— 'So
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. 7 — �f/S�/(
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $