HomeMy WebLinkAboutPV2021-261 - Permit Application (3)Pnn4,For`n ; I Worksheet for Combo Building $ Solar Permit �Application
j—; Comm'I C Y Residential City of Newport Beach - Building Division V A71, zol
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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❑Building C Grading CDrainage [- Elec r Mech C Plum cuvdcut � cuvdFin
Project Address (Not mailing address) ❑ Flood [; Fire r', Liq [Landslide CN/A Floor Suite No
333 Ula- Lido
Description of Work
Use Const Type L
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# Stories # Units (if Res)F-I
--------- -- --- --- --- --- ------ ----- --
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Valuation $ I $k
Material/Labor
New/Add SF Remodel SFF Garage/New/Add
OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
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City State Zip TelephoneF
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
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City State J ZipF—] Telephone
ARCHITECT/DESIGNER'S NAME /�
Last �� �,/' A� First FA—M-01-71 _Li[.No.
Architect/Designer's Address Architect/Designer's E-mail Address
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City -- — - - State Zip F Telephoner
ENGINEER'S NAME Last r First !Lic. No.
L_._- -- ---- -- — -- --
Engineer's Address Engineer's E-mail Address
City State i Zip Telephoned
CONTRACTOR'S NAME/COMPANY�3 �, Lic. No. �3(a2FJ� Class'
Contractor's Address Contractor's E-mail Address
City State �', Zip [77777 Telephoned
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
PERMIT NO. JVU2.1 Zdl
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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