HomeMy WebLinkAboutF2021-0469 - Permit Application (6)Print Form Worksheet for Combo Building & Solar Permit Application �'�W�Rr
C Comml Residential City of Newport Beach - Building Division "�'� /� z NOTE: PLAN CHECK FEES ni IF AT TlnnF nF ci IPRAITToi 1 ,/ �'o ,--
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F- Plum Cu Yd cut Cu Yd Fill
Project Address (Not mailing address) Flood
[_ Fire F_ Liq F Landslide F_N/A Floor Suite No
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�3 300
Description of Work
Use Const Type �%j
# Stories #Units (if Res)
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New/Add SF Remodel SF C?(o2 Garage/New/Add
Valuation $
Material/LaborSdi ov
OWNER'S NAME Last ,�i)First
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Owner's Address
Owner's E-mail Address
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City �M I-rA State A
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Zip 7671-7 Telephone f4l -135 84 V
APPLICANT'S NAME Last V rl v
First P"
Applicant's Address
Applicant's E-mail Address
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City I 1,RV1AiC State C4- Zip 4? t(q Telephone 7 � a?w
ARCH ITECT/DESIGNER'S NAME Last �1�li��� v "-
First Flal � Lic. No. f -. 321 35-
Architect/Designer's Address
Architect/Designer's E-mail Ad/dress
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City IX Ind State Fe�Zip TeIephonely
ENGINEER'S NAME Last &V /RY
First Lic. No. ��6781
Engineer's Address�l
Engineer's E-mail Address
City A) State &A Zip
9 Z g7 Telephone tj t' fO
`� 3 197j
CONTRACTOR'S NAME/COMPANY �� 9 Lic. No. 3%? %` Class
.V 1
Contractor's Address
Contractor's E-mail Address
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City State F2 Zip
el� Telephone � �' '3 74' -
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SETBACKS REAR SETBACKS FRONT
PERMIT NO. r
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO- r
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $