HomeMy WebLinkAboutX2021-1575 - Permit ApplicationPrint Form Wo eet for Combo Building & Solar Permit A plication 0641
Comm'I 9 Residential City of Newport Beach - Building Division ���' 1� I S
111111 2\ NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Buildin [_ Gradin&,Pfrainage F7 Elec Mech (— Plum Cu Yd cut [--, Cu Yd Fill l
Project Address (Not mailing address) F Flood r Fire Liq F- Landslide FN/A Floor Suite No
Description of Work
Use J Const Type
3��� ire e tr �w/tr
r
# Stories ` #Units (if Res) �
Valuation $ L/
Material/Labor
ccs
New/Add SFF -----, Remodel SF `Z rj-V Garage/New/Add --
OWNER'S NAME Last 1000 /lOOi r First
Owner's Address Owner's E-mail Address
2 -
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City
City AQ, A P f I Je.avL State GYr Zip 9?,66U Telephoned
APPLICANT'S NAME Last First I J& S c„ti
Applicant's Address Applicant's E-mail Address//
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?—loge __.13� t S} c los JayM@YA5/li`✓ re �o�L�f , °�
City �c,Yc� _.. State C,�. ZipF—,9 Z:/, Telephone
ARCHITE /DESIGNER'S NAME La t MIR First ]TASK F_
` Lic. No.F_
Architect/Designer's E-mail Address
City _. _ State F_ Zip I— Telephoner --.---
ENGINEER'S NAME Last C%ol 00 24 e First '(�� Lic. No.1
Engineer's Address Eng ineer'ss E-mailAddress
_1 -(To y/
City 59 GGt"ft� _' State L`/9._. Zip... $/G.. Telephone F%�`l.- 9Rlr—../Z9
CONTRACTOR'S NAME/COMPANY ��ls�i In ev�s Lic. No.53 81 y21 Class /3
Contractor's Address Contractor's E-mail Address
24)98 15,9L_1�1_ay Sk-lev JaSui.@insP,'rco�leMe[�is,�or�
City `m_vE rvm)i _.. State (,A Zip _%Z63o _ Telephone 9CIP,7/6 - mg
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBAC L SETBACKS RIGHT PLAN CHECK NO.
USE ZO E tDEVELOPMENT NO PLAN CHECK FEES $
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