HomeMy WebLinkAboutX2021-3130 - Permit ApplicationPrint Form I Work�sh/eet
r Comm'I _Residential Y
for Combo Building & Solar Permit Application /r///e °,
City of Newport Beach - Building Division `3
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
C
uilding F_ Grading F-Drainage �ec F_Mech Plum CuYdCut � uYdFill ''Pr\oiject
Address (Not mailing address) F_ Flood F_ Fire F_ Liq r Landslide /A Floor Suite No
Description of Work
Use t_ Const Type
� ��� n�'�124y�
# Stories # Units (if Res)F—
Valuation $ gyp, ...
Material/Labor � e) 00 -
ev /Add SF 'L 21 Remodel SF � Garage/New/Add
l/
OWNER'S NAME Last 6 ry'rl First a� a
Owner's Address Owner's E-mail Address
1 n_'
Iv-.,;ei D/-
City aY� _ ?;ak - ' State Zip M Telephon C �T7-3,p
APPLICANT'S NA E Last Ui First F
Applicant's Address Applicant's E-mail Address
- �.j ' CIt/Vi7 a
lJ( ' 6 _..1 Y z:ta � .
City State r 5F Zip Telephon
ARCHITECT/DESI NER'SNAME Last D�� FirstI�Klj
` Lic.No.
u�
Architect/Designees Address Archite esi -mail Address
23- vi60<4a, h iE- vrn�;0,
�— 2
ty State Zip q Telephone C,1 r t) c 7r -z6z_j�.
ENGINEER'S NAME Last First �avLic. No.
Engineer's Address En 'neer's E-mail Address
CA, si one.
City � � State I Zip 27 t Telephone 71 � B35' �
CONTRACTOR'S NAME/COMPANY jJ I _ ,1� /,,,,.�d1 Lic.No. 9� ClassF
4Gv� G.FJW L v
Contractor's Address Con`trractt`or'ss E-mail Address
City State �— Zip Telephone
.c
r
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. l
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $