HomeMy WebLinkAboutX2021-2552 - Permit Application (2)Pmt,�orm ;g Wor4mbeet for Combo Building & Solar Permit Application o�EW�Re
F_ Comm'I r- Residential City of Newport Beach - Building Division XX��1 O////��)� �
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMIT T}XL 21 O G<;.oa .
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Project Address (Not mailing address) r Flood F Fire F, Liq Landslide FN/A Floor Suite No
Description of Work
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#Stories #Units if Res)F-
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Valuation 5 2�
Material/Labor 2_ �
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New/Add SIF Remodel SF ®!r - Garage/New/Add �—
OWNER$NAME Last First
Owner's Address Owner's E-mail Address
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City I Y l State FEA Zip q TelephoneF777777
APPLICANT'S NAME Last ( .�,.-� - - -- First
Applicant's Applicant's E-mail Addreg
iAddress
City StateF Zip ... G� ?2Telephone ChL�� 2 Z(n --713D
E Last �— �_ First C ��b
J r` Lic. No
Architec�Desi� r' Address Architect/Designees dress
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City0. J' .. State ����— Zip ! el 01b j -Z -7/-30
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ENGINEER'S NAME Last �1 First Lic. No f
Engineer's Address Engineer's E-mail Address
City State F Zip I TelephoneF77777
CONTRACTOR'S NAME/COMPANY Lic. No. 7866 5 9 Class GT L('I
Contractor's Address Contractor's E-mail Address
City State �— Zip Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK N0.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $ s �`