HomeMy WebLinkAboutpv2021-215 - Permit Applicationrrmt rorm vvorKsneei Tor a:Omoo buliaing & solar Permit Application ?EWPoR,
Comm'I City of Newport Beach Building Division (`
( r Residential ji\;2l
NOTE: PLAN CHECK FEES DUE AT TiMF nF ci iannirrni t V
Building [GradingDrainage j Elec Mech r Plum cuvdCut
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Project Address (Not mailing address) Flood r 111 _
Fire _ Liq Landslide Floor Suite No
Description of Work
1 i r r Use Const Typemo !
# Storiest # Units (if Res)t
Q
Valuation $ ,
New/Add SFt— Remodel SFt-- G rage/N w/Add t Material/Labor i ?
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OWNER'S NAME Last
First
Owner's Address Owner's E-mail Address
City State F__— Zip F_ Telephone—
APPLICANT'S NAME Lastl i 'TuS First 1 ,,
Applicant's Address Applicant's E-mail Address
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CityC' T - — k 11 ��- State (_T Zip t, v U , Telephone
ARCHITECT/DESIGNER'S NAME Last First
_---- Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
-- -- - — -- - --
— — — -- ----- ----- --
city — State Zip �— Telephoner
ENGINEER'S NAME Last Lic. No
First �—
.
Engineer's Address Engineers E-mail Address
--- - — -
City State Zip F_- Telephonet
CONTRACTOR'S NAME/COMPANY` t ;t ? Lic. No. Class11
Contractor's Address Contractor's E-mail Address
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City ,I '' State { Zip r > F
! k Telephone
SETBACKS REAR SETBACKS FRONT = tmN%t v t PERMIT N0. 0 e )
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $