HomeMy WebLinkAboutX2021-0070 - Permit Application<'1Vorksheet for Combo Building & Solar PermWApplication`
Residential
Grading
roject Address (Nc(t n
of Work
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City of Newport Beach - Building Division X UZ I -0&:=t0
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Elec Mech �, Plum Cu
Cu Yd Fill
Flood ❑ Fire I Liq 17 Landslide ❑N/A Floor
Suite No
VAUse Const Type
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# Stories # Units (if Res)
New/Add SF � Remodel SF Valuation $
J �— Garage/New/Aif]
Material/Labor
OWNER'S NAME Last ' (" lq 111 _
First0
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Owner's Address — --- - -_.-.-
Owner's E-mail Address
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City >u'3 -
StatT;7
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APPLICANT'S NAME Last
Applicant's Address
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City _l-byx.a-.-------- .
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ARCHITECT/DESIGNER'S NAME
First
Applicant's E-mail Address
Zip 4 Zt?Q Telephon y L� bb2A I
Last [77777First F—
ArchitecttDesigner's Address
City State �—
Lic. No. 177777
Architect/Designer's E-mail Address
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ZIP Telephone
ENGINEER'S NAME LastFirst ., �� _
tom. IL ,-.-� Lic. No. � �
-- - --- , �
Engineer's Address Engineer's E-mail Address
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I t�/
City State Zip c� Telephon
CONTRACTOR'S NAME/COMPANY
SC=q Pbw1',..-Cwt - Lic.No. Ld1/X Class
Contractor's Address
-
Clry State
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT
SETBACKS RIGHT
Contractor's Email Address
Zip ](a) TelephonP��) ala l _ 7�v17
PERMIT NO.
PLAN CHECK NO.