HomeMy WebLinkAboutX2021-2151 - Permit ApplicationA Z�u/ I �
Worksheet for ombo Building & Solar Permit Application�R.
I j Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL J ,.
G<roaxr
F
ilding r Grading I—Drainage �Elec Mech y�
/A PIUm Cu Yd Cut Cu Yd Fill
ject Address (Not mailing address) Flood `Fire
r- Liq f- Landslide rN/A Floor
Suite No
cription of Work I' �
bLj ( phi r Use Const Type
# Stor' s # Units (if R s)z
New/Add SFF-- Remodel SF F TS Garage/New/Add f ----- Valuation ///
- - _ Material/Labor
OWNER'S NAME VL
Last V � First ��CJ
Owner's Address _ _ - _... _ nn
Owner's E-mail Address l- „
City I 'o [2z 1•.h�. i'7 tZ L c� State
Zlpg� Telephone CN
q_ � Z9 — ?%S'7
APPLICANT'S NAME
Last FirstrstI
Applicant's Address -
Applicant's E-mail Address r
City State �
V
I ZIP [--- TelephoneF�—,
ARCHITECT/DESIGNER'S NAME
Last f --.—_- _ First [---
Architect/Designer's Address Lic. No.
I
ArchitecVDesigner's E-mail Address
CityJ
State Zip r� Telephoned_—_—_ 1t�
ENGINEER'S NAME Last
a First Lic, NoIs
Engineer's Address
Engineer -mail Address
City
State �-_' Zip � Telephoned--�—�
FContractorft
'S NAME/COMPANY
��%cg�cm of ro. �r�2 Lic. No. 1S 3
ress Contractor's E-mail Address
r"t-*-Nc1AcrS�tL�cOnS �uowl v+-u� State C Zip Telephone( _ rya — IESETBACKS
SETBACKS FRONTPERMIT NO. �(Z(j� —SETBACKS RIGHT/PLAN CHECK NO. 1
DEVELOPMENT NO
PLAN CHECK FEES $