HomeMy WebLinkAboutX2021-1347 - Permit ApplicationX 2-I J 3 q1
Print Form Worksheet for Combo Building & Solar Permit Application
(- Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building F_ Grading rDrainage P( Elec rMech r Plum Cu Yd cut F Cu Yd Fill
Project Address (Not mailing address) r Flood r Fire r Liq f- Landslide F_N/A Floor Suite No
Description of Work
Use F— Canst Type
# Stories # Units (if Res)[
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valuation s. �
Material/Labor..
OWNER'S NAME Last
First s ZLt $ t /J
Owner's Address
.Owner's E-mail Address
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State" Zip ei Zd6(. TelephoneR�``J%%
APPLICANT'S NAME Last77
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Applicant's Address
- .Applicant's E-mail Address
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City I s f
State (° Zip ,�b7'I Tele hone d Yoe .•.J.
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ARCHITECT/DESIGNER'S NAME
Last First r--- Lic. No. r — ---
Architect/Designer'sAddress
Architect/Designer's E-mail Address
City
State Zip-- Telephoner -`
ENGINEER'S NAME Last
Firstf ----• Lic. No.F_
Engineer's Address
Engineer's E-mail Address
City -
State F Zip r TelephoneF-------
CONTRACTOR'S NAME/COMPANY
y� � a Lic. No. cjj Class C
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Contractor's Address
Contractor's E-mail Address
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REAR
SETBACKS FRONT PERMIT NO.L 34 7
LEFT
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SETBACKS RIGHT PLAN CHECK NO. i Z�q- LU?�-i
DEVELOPMENT NO D2D'LO - 0 5 PLAN CHECK FEES $