HomeMy WebLinkAboutX2021-1436 - Permit ApplicationPrint Form Wo _ it for Combo Building & Solar Permit Application o 9P�
Vomm'I sidential y City of Newport Beach - Building Division _
\ NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F-Building F Grading aaage F Elec r Mech r Plum Cu YdcutF Cu Yd Fill l
Project Address (Not mailing address) r Flood Fire F_ Liq r Landslide N/A Floor Suite No
Description of Work G�%104z) 0/,M'-70� Y F7*0 Const Type V�
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# Stories # Units (if Res)
Valuation$ ^!
New/Add SF lI �-� �Ql% 5� Garage/New/Add Material/Labor J
OWNER'S NAME Last r/ )'f-_ /1C_�11A,4G C! First
Owner's Address Owner's E-mail Address
City, ^—....—.,.—.-- State �----- Zip F_ TelephoneF_
APPLICANT'S NAME Last : /zU X First r%_�;'Ai �(
Applicant's Address Applicant's E-mail Address
City iZ�S State � - Zip �� � Telephone / `5 7 G%
ARCHITECT/DESIGNER'S NAME Last r?IN/ R / First R-/A/t)0y Lic. No. - '� ZZZ
Architect/Designer's Address Architect/Designer's E-mail Address
City _ State F_ Zip F_ TelephoneF—
ENGINEER'S NAME Last
First
Lic. No.F—
Engineer's Address Engineer's E-mail Address
City I State �— Zip �— TelephoneF_
CONTRACTOR'S NAME/COMPANY .1 Lic No. IC'C Class
Contractor's Address Contractor's E-mail Address
t^o<1 / jr-C��G��` UAL% Ca- CAM
City , U,v ✓ I Cv State �l�r'� Zip [ G v Telephone �f % 7� SI D l�
SETBACKS REAR
SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $