HomeMy WebLinkAboutX2021-1085 - Permit ApplicationPrint Form
L _ I Worksneet for Gombo building & Solar Permit Application
Corsi Residential City of Newport Beach - Building Division
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f Building
LAN CHECK FEES DU TIME OF SUBMITTAL
Grading
Elec XMech
Project Address (Not mailing address) F Flood
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of Work
New/Add SF; 3(�/ Remodel SF i_l
OWNER'S NAME
Last
Owner's Address j I
City i NewPpr� dXGC� _ State C —
APPLICANT'S NAME
Applicant's Address
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City r
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ARCHITECT/DESIG
Last
Plum Cu Yd
F Fire F Liq T_ Landslide
beach, CA 92M
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Cu Yd Fill
(—N/A Floor
Suite
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# Stories Units (if
Valuation $ • Z�U ��� _
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First I N I Gh-) ks
Owner's E-mail Address
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Zip Z�Zo_ Telephone[[ J J 4t6-
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First
Applicant's E-mail Address
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Zip i Telephone --
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Last �oar� First —`
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Architect/Designer'sLic N Address
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_ State � (A
ENGINEER`S NAME
Enginee[ s Address
City
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Architect/Designer's E-mail Address o^ ';i"?.-F
John doan S39 9Maijt,t
Zip JR283Z Telephone[ (Gz�)j2'-Og7Z
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l Lic. No.l 5 (p ` -7 I —
Engineer's E-mail Address
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State I -C jA zip
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CONTRACTOR'S NAME/COMPANY
Contractors Address
City
State
E SETBACKS REAR
'SETBACKSLEFT
SETBACKS FRONT
SETBACKS RIGHT
Lic. No. i Class
Contractor's E-mail Address
Zip Telephone
PERMIT NO.
Q_f, 2 r�PL(AAN CHECK NO.
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