HomeMy WebLinkAboutX2021-0395 - Permit Application (2)Print Form "Worhsheet for Combo Building & Solar P rmit Application
City of Newport Beach - Building Division
j— Comm'I Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
`Building F_ Grading F—Drainage F_ Elec f— Mech
(— Plum Cu Yd Cut Cu Yd Fill F
Project Address (Not mailing address) F_ Flood
F_ Fire F- Liq F- Landslide F_N/A Floor Suite No
Description of Work
Use �_ Const
l fType I Vi F.
Stories #Units (if Res)
Valuation $
New/Add SF 2 (g Remodel SF 7:5,f> Garage/New/Add
—
Material/Labor b
OWNER'S NAME Last;o v,_C=t- n ,r-� 1
First �✓'-Q-� _EL
Owner's Address
Owner's E-mail Address
City State I L JET-
Zip u, 3 TelephcCe-7
APPLICANT'S NAME Last rVI)
First
Applicant's Address
Applicant's E-mail Address
� -z
City 1vJ State Zip Telephone 3 �J 2_
ARCHITECT/DESIGNER'S NAME Last G�r,��
First, Lic. No.�
Architect/Designer's Address
7
Arch itect/Designer's E-mail Address
F_
City I State
Zip I Telephone
ENGINEER'S NAME Last O y, �-
Firsts, Lic. No. 4 3
Engineer's Address
Engineer's E-mail Address
j
City �T, State Zip �-?-73 v Telephon -7 A- +6 ZS 37
CONTRACTOR'S NAME/COMPANY 1 ��
Lic. No. Class
Contractor's Address
Contractor's E-mail Address
City State F_ Zip �— Telephoned
SETBACKS REAR SETBACKS FRONT
PERMIT NO. At 0
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $