HomeMy WebLinkAboutX2021-3171 - Permit ApplicationPrint Form '
Worksheet for Combo Building & Solar Permit Application o EW>orm
f Comm'I k Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
`Building j— Grading
(—Drainage (— Elec F Mech f` Plum cuvdCut s
Project Address (Not mailin Cu Yd Fill
g address) F Flood F Firer Liq r Landslide [N/A
2731 3AJ:E �oRc Floor Suite No
escription of Work � `JPDQ<4(
�00 � Use F Const Type r-
# Stories # Units (if Resf
New/Add SFF � _
Remodel SFr—� Garage/New/Add Valuation $
OWNER'S NAME Material/Labor
Last 'w c�7
Owner's Address V First 0 [A / J
T3 � ?A `/5 k u�pi U Owner's E-mail Address
City j\Jf-_t,.,pvj -t iJ1�-lAc�t State FA�R�11G�_��itk(juSC.C2uv,
Zip F — Telephone Za7
APPLICANT'S NAME _ )
Applicant's Address .J
Last ' _
-%En-ldj6--_.-.... First �.
j —70 Applicant's E-mail Address
city Nit, P uk .3
{`t1c 1,.1 state ARCHITECT/DESIGNER'S NAME ZIP FM CC Telephone , _
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Last ,
Architect/Designer'sAddress A���°^� First Cmi,
Lic. No. �—
D qkj 4i:r-�i c�w l,1 5T Architect/Designer's E-mail Address
City
i$C State Ir/ Zip bJ7l ; -
Telephone 7W j
ENGINEER'S NAME
Last 50 Z0
Engineer's Address FirstLic. No.
Engineer's E-mail Address
City
State r � Zip j�--
Telephones--
CONTRACTOR'S NAME/COMPANY SI Pyil t� LC N�;,&C5 Lic. No. �Op 7��
Contractor's Address I 3 ` Classr—
n0 i Jewro,,-t C$ljl VL Qr, Contractor's E-mail Address
city (uF°F T 13eA State FCA Zip JJh 6s�— `woyc ' awe
Telephone Zo i 6S u 630
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT
SETBACKS RIGHT
USE ZONE
DEVELOPMENT NO
PERMIT NO. 172,czt 0i-"-P
PLAN CHECK N0.
PLAN CHECK FEES $