HomeMy WebLinkAboutX2021-2272 - Permit ApplicationPrint Farm Worksheet for Combo Building & Solar Permit Application (04%
X`2-02 r 2'2%2- City of Newport Beach - Building Divisionr, Comm'I residentialNOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) ❑ Flood r Fire r Liq n Landslide rN/Ar FloorSuite No
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Description of Work
Use Const Type
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# StoriesF_ # Units (if Res) '
Valuation $
Material/Labor
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New/Add SF �, Remodel SF 1
Garage/New/Add
OWNER'S NAME
Last L@ i�eC M®rl
First%
Owner's Address
Owner's E-mail Address
City Ne_W D(k_ _ e a —_ State ' Zip O Telephone
APPLICANT'S NAME
LastFirst
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Applicant's Address
Applicant's E-mail Address
+�j'414_ (Win $}
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i—
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City WOC�q�o�� �i ��5
State
Zip l�lTelephoneg(cd'2-2%-9455)
ARCHITECT/DESIGNER'S NAME Last
First Lic. No. 1
Architect/Designer's Address
Architect/Designees E-mail Address
City
State 'i
Zip Telephoner
ENGINEER'S NAME
Last �—
First Lic. No.�
Engineer's Address
Engineer's E-mail Address
City
State F
Zip ! Telephone
CONTRACTOR'S NAME/COMPANY
ii''06KLic. No. oil a�� 'Class'
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Contractor's Address
Contractor's E-mail Address C139
3411 U,
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&W Qt 2o1ci
City , 6ll
State
Zip ft Telephone �( rX
t 1
SETBACKS REAR
SETBACKS FRONT
PERMIT NO. �b�b�
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO. i
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $