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X2021-1815 - Permit Application
x�o2 � � Print For Worksheet for Combo Building & Solar Permit pplication o ePPo.a Comm'I r Residential City of Newport Beach - Building Division - NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL ❑..oar" wilding [-Grading Drainage [Elec rMech [ Plum Cu Yd Cut F_Cu Yd Filll Project Address (Not mailing address) r— Flood f— Fire F_ Liq r— Landslide FN/A Floor Suite No Description of Work Use F—ConstType # Stories[— # Units (if Res)F— Valuation $ 0 Material/LaborROW New/Add SFr --' Remodel SF aO Garage/New/Add r- - OWNER'S NAME Last First Owner's Address Owner's E-mail Address v © Da City �(�,�r� State Il.�'. zip �o2lo,f 7 _. Telephone-�,V APPLICANT'S NAME Last �% First Applicant's Address Applicant's E-mail Address -- / G/�c �qe� City l/ V i State �f i Zip �,, r'p�/ Toephone %e/r ,V7 �j�pa7 ARCHITECT/DESIGNERS NAME Last First r Lic. No. r ��� f?f� Architect/Designer's Address Architect/Designer's E-mail Address �m City State r Zip Telephoner-- ENGINEER'S NAME Last First F Lic. No. Engineer's Address Engineer's E-mail Address City '. State F_--- Zip [.-_---, Telephoned.-— CONTRACTOR'S NAME/COMPANY/a✓/��� 9 LIC.No. ��5�3 Class I Contractor's Address ntractor's E-mail ddress City j o I State -' ��lephoner- Zip G��C� -ICY SETBACKS REAR SETBACKS FRONT PERMIT NO. THINI,I\� . SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. \ USE ZONE DEVELOPMENT NO PLAN CHECK FEES $