HomeMy WebLinkAboutX2021-2346 - Permit ApplicationPrint Form_ Worksheet for Combo Buildin & Solar Permit 61 11 t�t-�
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Comm'I (J Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building ❑ Grading Drainage AElec ❑ Mech [j Plum Cu Yd CutE-] Cu Yd Fill F 1
Project Address (Not mailing address) F! Flood ❑Fire ❑ Liq 1 Landslide [—',N/A Floor Suite No
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Description of Work
New/Add SF�^ ; Remodel SF G I Garage/New/Add
Use 1171tri(cConst Type
# Stories -&-1 # Units (if Res)F
Valuation $ / e,
Material/Labor lv l
OWNER'S NAME �v
Last ��[�i-_(.✓J��7� First._.__.—_--------------------------.-1
Owner's Address Owner's E-mail Address
City ._--_..•LIz1//n/ - State Zip E _LLJ Telephone
APPLICANT'S NAME Last
Applicant's Address
City D[Gr�:` State
First
Applicant's E-mail Address
L14
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Zip Telephone Z - ��i >0
ARCHITECT/DESIGNER'S NAME 7 Last First { Lic. No. G G l �-
j% �7 I - ((� I / ' l
Architect/Designer's Address
City r f j-,tq%GJ✓� ��� State U
Architect/Designer's E-mail Address
l
Zip Z6.�j Telephone C06 C%
ENGINEER'S NAME Last First �— _ Lic. No.�
Engineer's Address
i
City State j
Engineer's E-mail Address
Zip Telephone i
CONTRACTOR'S NAME/COMPANY ''j( Lic. No. -( Class I l
Contractor's Address
City C State
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT
SETBACKS RIGHT
Contractor's E-mail Address
de1,S. COcv
zip.tA26 I— Telephone
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PERMIT NO. �Vy \ I/ Ao
PLAN CHECK NO. L� l� W
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $