HomeMy WebLinkAboutX2021-0205 - Permit ApplicationPrint Form WC
r Comm'I r Residential
imbeet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division
.'x NOTE: PLAN CHECK FEES DUE AAeE OF SUBMITTAL
r Building F_ Grading
ject Address (Not maili
of Work
New/Add SFF— Remodel SF
r- Elec
Ate) L-.
F_ Mech F_ Plum _C"'
r Flood F_ Fire F_ Liq
--t C) k
Cu Yd Fill
Suite No
ConstType F_
fFa5l000
� -e
# Units (if Res)F_
d or
OWNER'S NAME Last w 7✓ r i b First
Owner's Address Owner's E-mail Address
t k /`,t i°cC ✓k 1'vC <
City State Zip C?,&Z � Telephone �"� r� -�� � —��O
APPLICANT'S NAME Last
Applicant's Address
0,
City f J f j �i State t_ r�
ARCHITECT/DESIGNER'S NAME Last
First I _� i_
Applicant's E-mail Address <�
Zip Fi 3 Telephone
First F_ Lic. No.
Architect/Designer's Address Architect/Designees E-mail Address
City
�� � State �s•--�_ Zip F--- Telephoned----
ENGINEER'S NAME Last First F--- Lic. No.F---
Engineer's Address Engineer's E-mail Address
City
State r-- Zip F— Telephoned---- CONTRACTOR'S NAME/COMPANY /A y L ,R tiffs (v�PC Lic. No.
Q L Class
Contractor's Address
Contractor's E-mail Address S ��
7 State Zip Telephoned —
City tj
SETBACKS REAR
SETBACKS FRONT PERMIT NO.
v
SETBACKS LEFT SETBACKS RIGHT / PLAN CHECK NO.
USE ZONE DEVELOPMENT NO 'L1C-V ` 7C; PLAN CHECK FEES $