HomeMy WebLinkAboutX2021-3390 - Permit Application (2)i=nnt Foam'�/I/ Worr
for Combo Building &Solar Permit Application
r Comm'I �s I City of Newport Beach -Building Division XVI -Wo
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`` 1 OTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
[-Building [Grading ; rainage r7Elec r_Mech F- plum Cu Yd Cut Cu Yd Filll
VIII II
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Project Address (Not mailing address) 1- Flood (� Fire Liq Landslide /A Floor Suite No
Description of Work AS
k onst Type
i— ti
nits (if R )A
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New/AddSF�— Remodel SF Garage/New/Add -
tion
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OWNER'S NAME Last -_-L_ __.-_-_ _... _, First JU S (a
Owner's Address Owner's E-mail Address
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City �Z ?-,4_t_ a State r Zip �— Telephone
APPLICANT'S NAME Last �jyl� First I
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Applicant's Address Applicant's E-mail Address
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City �WAR1 � State G¢j Zip 4�$�) Telephoned 1 ,
ARCHITECT/DESIGNER'S NAME Last h)/1. --- _.__._i First )G N rTc�__--- Lic. No. �—
Architect/Designer's Address ArchitectlDesigner's E-mail Address
--APLa_CA—'-- —
city - - State Zip �— Telephone�—
ENGINEER'S NAME Last First Lic. No.
Engineer's Address Engineer's E-mail Address Vv
_ ----- -- _...
City State I — Zip I--- Telephone��
CONTRACTOR'S NAME/COMPANY Lic. No. ClassF
Contractor's Address Contractor's E-mail Address
Tele hone
Cit State Zip p
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SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. /a
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $