HomeMy WebLinkAboutPV2021-063 - Permit ApplicationN2,0 -:M, 00O3
Print Form W 'A"sh-4ft for Combo Building & Solar Permit Applicationl *01
F Comm'I F_ ResidentiaCity of Newport Beach - Building DivisionNOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
`Building f- Grading Dr ' age f— Elec r Mech r Plum cuvdCut Fcu Fill
Project Address (Not mailing address) F_ Flood Fire j` Liq andslide N/A FloorSuite No
L( ;Dry
Description of Work
Use^ s Const Type
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# Sto ie # Units (if Res)F_
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New/Add SF�— Remodel SFF--'
Garage/New/Add F--
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OWNER'S NAME Lastn{{ii
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.First T`nd,,u
Owner's Address
Owner's E-mail Address
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City IN ? Ofk,r-, t cy i State / t
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APPLICANT'S NAME Last -5—
First ''F
Applicant's Address
Applicant's E-mail Address
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City ��dN4'� �". State
Zip %ter✓ TelephoneF,"711) o r.. j.
ARCHITE /DESIGNE7ess NAME) st i IpJ -j? ,
First Lic. No. �--.—__.._.
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Architec
Architect/Designer's E -mai Address
City -..... -. -. - State F_
Zip �- Telephoner-.---.---.
ENGINEER'S NAME
Last FirstTFAddre:ss :Lic.No.Engineer's
Address.
Engineer's
City State �—
Zip Telephone��
CONTRACTOR'S NAME/COMPANYr 21 �Eor-16 iv Lic. No. — Class
Contractor's Address
Contractor's E-mail Address-
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City.,C,, ,�N�,L _ 3 CCW l� State L
Zip 2-E Stj Telephone. 1
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REAR SETBACKS FRONT
PERMIT NO.LEFT
SETBACKS RIGHT
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PLAN CHECK NO.
DEVELOPMENT NO
PLAN CHECK FEES $
sem'% x .1d,