HomeMy WebLinkAboutX2021-2965 - Permit ApplicationP�i�t Foam Worksheet for Combo Building & Solar Permit ApplicationE `W�RB
n Coni r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL ���>aa�"
rBuilding rGrading r,Drainage Iec [—!Mech r, Plum CuvdCut F_ cuvdFill 17
Project Address (Not mailing address) ri Flood r Fire r Liq r Landslide r'N/A Floor Suite No
Description of Work GG �
Use -! Const Type
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#Units (if Res)�II
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Valuation
Material/Labor 2S/��b vUj
New/Add SFF Remodel SFF Garage/New/Add �',
OWNER'S NAME Last UO RA First G
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Owner's Address Owner's E-mail Address
City C�-\-�IYA D.PI . n_�- -_--- State Zip ' Telephone ��L� GI'G
APPLICANT'S NAME Last p ,� FirstE _._
Applicant's Address Applicant's E-mail Address
City ...F�� rf tate I (_FF I Zip Telephone � 1G(—Ll(�L
U �1
ARCHITECT/DESIGNER'S NAME Last FirstF Llic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City— _-_ State Zip Telephoned
ENGINEER'S NAME Last First F Lic. No.
Engineer's Address Engineer's E-mail Address
--11 6
City State �I Zip Telephon "r
CONTRACTOR'S NAME/COMPANY Lic. No. 7��2 Class
01-f 6 Kc1
Contractor's Address Contractor's E-mail Address
(0-7 16 V
City ' `re State Zip q ///) ^^^
&Telephone%V��RO( /� _7( crogq
SETBACKS REAR SETBACKS FRONT PERMIT NO. V
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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