HomeMy WebLinkAboutX2021-2847 - Permit ApplicationPrint Form %, Worksheet for Combo Building & Solar Per m't Applicat�iqo�n @-gagi,
omm'I F_ Residential City of Newport Beach - Building Division o 21 - Z b h ��
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL oa
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Project Address (Not mailing address) 1- Flood r Fire f Liq r Landslide F_N/A Floor Suite No
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Description of Work
Use s Const Type s
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# Stories # Units (if Res)s
Valuation $
Material/Labor 3i av�
New/Add SFF Remodel SF F_ Garage/New/Add F-
OWNER'S NAME Last Oh0A0..L "'o U4 k r First
Owner's Address Owner's E-mail Address
-(74s Sita 60PvVeYDv, -k.200__
City «tgk�sti-AS 9awck State I HCl ZipTele P hone gSl.6 4 37
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APPLICANT'S NAME Last tt U First makK
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Applicant's ddress Applicant's E-mail Address
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City CL.Ke ^>ctx0re State Zip �Y,*
( ?516,04.-4637
^Telephone
ARCHITECT/DESIGNER'S NAME Last IZOWLe r p First C Yr� - Lic. No. c_ (i3 p ei
Architect/Designer's Address Architect/Designer's E-mail Address
17 I ��. C?vr� - �j ce-
City U /Lt �p �eGf� State Zip L� Telephone 7/ (
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ENGINEER'S NAME First j�� b py Lic. No. j - fj q—ss
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Engineer's Address Engineer's E-mail Address
-17 4 /-L W , A -v e .
CityF/ �yaPIL, a State CM Zip
V Telephone 7���.y.
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CONTRACTOR'SNAMElCOMPANYAAA pLE$�Dy(t ;Ul{� /�e� Lic No. Classy
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Contractor's Address Contractor's -mail Address
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City F44e CC S l K ej Y e State �— Zip 72 53l Telephone /1 ?�
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SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $