HomeMy WebLinkAboutX2021-0028 - Permit Application'PrintForory ! Worksheet for C"btfibo'Bui#dingw&°Solar Permit AppBicatiori'
F Comm'I F- Residential City of Newport Beach - Building Division ,Cto I
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F -Building [ Grading r --Drainage F_ Elec FW Mech F- Plum Cu Yd Cut Cu Yd Fill l
Project Address (Not mailing address) F— Flood F Fire Liq F- Landslide CN/A Floor Suite No
Description of Work
"Use � Const Type �..
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/ / � J
�- y C. it R �._I I C'�'fj C
# Stories #Units (if Res)[—
Material/Labor j, 61131
New/Add SFF------ Remodel SFI Garage/New/Add---
OWNER'S NAME Last
; First 1 %"��a.'T
Owner's Address
Owner's E-mail Address
City r
State F Zip F TelephoneF_
APPLICANT'S NAME LastzLj
First '
ry : sew
A/pplicl/a/n/{t's Address
Applicant's E-mail Address
J
/ �.5si�/1.11.Ly1
City /� � ',
State Zip �?2`✓t,( Telephone 1:2w L3
ARCHITECT/DESIGNER'S NAME
Last First F_ Lic. No. — -
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State F Zip F— Telephone`
ENGINEER'S NAME Last
First Lic.. No
I
Engineer's Address
® Engineer's E-mail Address
�[1.7ir
City F
F J
State Zip - - Telephone
CONTRACTOR'S NAME/COMPANY
/t (Lic. No. ty; _ „l Class
Contractor's Address
Contractor's E-mail Address
Ito- may, . / �' `�
� r
�e n / �50Cw1zYGu"�
city> ,
( Telephone ✓ 3
SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $