HomeMy WebLinkAboutX2021-0607 - Permit Application (2)- � V D t
Print Form Worksheet for Combo Building & Solar Permit Application o�11, P°R
Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL C9<c00.NP
[--Building (� Grading
[—Drainage Elec �x`Mech - r_--plum CuYdCut CuYdFill
Project Address (Not mailing address) Flood Fire r- Liq F_ Landslide FN/A Floor Suite No
Description of Work
Use [_ Const Type
# Stories # Units (if Res)[-
$
Material/Labor l> x"
New/Add SF
490-1Valuation
Remodel SF O(� �� Garage/New/Add �®
OWNER'S NAME
Last First 1�p�
11
Owner's Address501anne
A
...... . . . .......... . ........... . ......... Owner's E-maiddress
Ct CW
15
City
State Zip Telephone
APPLICANT'S NAME
Last First Y-
Applicant's Address
Applicant's E-mail Address
�iA ^V<i%�,`r � • �.
City 7
State Fa- Zi Telephoner* I dj (�ti
ARCHITECT/DESIGNER'S NAME Last Y%n ,K First F Lic. No.
Architect/Designer's Address
F srnm��_
Architect/Designer's E-mail Address
I .. ______
City
State Zip Telephone 7 � t+5(Q5
ENGINEER'S NAME
Last First F Lic. No.1�
Engineer's Address
Engineer's E-mail Address
City
State F Zip Telephoned
CONTRACTOR'S NAME/COMPANY T'VI „ e. NI `I Lic. No. �( Class Ft
Contractor's Address
Contractor's E-mail Address
City
State Zip Telephoned
SETBACKS REAR
SETBACKS FRONT PERMIT NO. fl-pLona-
xk__2�
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. -0 SI:� 1W
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $0'�T . 'r'6
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