HomeMy WebLinkAboutX2021-1062 - Permit ApplicationPrint Form IWorksheet for Combo Building
r Comm'I Residential City of Newport Beach- Building Divis& Solar ion �1? o ppl�Cl�lronZ
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL 0 9 -7 2A c
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Project Address (Not mailing address 1- Flood Cu Yd cuc�' cu Yd Fill
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Description of Work
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New/Add SF 131 pz- Remodel SF �' (
7�' Garage/New/Add �! Valuation $ 5 I Q Material/Labor ...J /
OWNER'S NAME - — ,
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Owner's Address First l�s r-:D
i U f 3 KS 112 Owner's E-mail Address MAY 06 2021
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State— GONSULTLNG GROUP
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APPLICANT'S NAME Zq8— 1'SG I
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Applicant's Address First N%
76�rl Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Telephone 177I 642_� 2 12
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Architect/Designer's Address A First �-- ZS
Lic. No. O
Architect/Designer's CZ i QDesigner's E-mail Address
City -
State � Zip
Telephoner I
ENGINEER'S NAME
Last �0'� E �� ./
First - 1 ,:-
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Engineer's Address Lic. No. 7 TFT
7L=Engineer's E-mail Address
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6 �$ Telephone *-'11 5252 —1 6 ( Z
CONTRACTOR'S NAME/COMPANY l
Contractor's Address Lic. No. Class
Contractor's E-mail Address
City
State Zip Telephone
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SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT
— SETBACKS RIGHT
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DEVELOPMENT NO
PERMIT NO. XZOZ� _ `' (j
PLAN CHECK NO. Q ct7�=
PLAN CHECK FEES $ -Soo C,
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