HomeMy WebLinkAboutX2021-2908 - Permit ApplicationX,2 og
Print Form Works eet for Combo Building & Solar Permit Application
F Comm'I esidentia City of Newport Beach - Building Division
I NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F—Building ( Grading" inage [_ Elec [_ Mech [— Plum CuYdCut CuYdFill
Address (Not mailing address) F Flood F_ Fire F_ Liq F Landslide
Description of Work
F`N/A Floor Suite No
Use ist Type
# Stories # Units
'1 U c
_ Valuation $
New/Add SF " ) Remodel SF �' Garage/New/Add Material/La
r
OWNER'S NAME Last I 1��� First I� vl��
Owner's Address Owner's E-mail Address
City 9 ' �; State Zip 2i . Telephone 7-- 116 1_1!�
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
1 F� 7 ►f 5 4 ;�-mil .� 4 c sm i4 G Gov►
City �j�q P7 State & Zip _46,fej Telephone -3
ARCHITEC /DESIGNER'S�I AME Last I �,.=�'% First (". Lic. No.
F7
Architect/Designer's Address Architect/Designer's E-mail Address
City I C l r �,G� State �,/� Zip Telephone q'7-2— 14,
ENGINEER'S NAME Last (j First Lic. No. I C -,-7 o •z-S
Engineer's Address Engineer's E-mail Address
City ` State %,Q Zip �j 7vt5 Telephoner,
CONTRACTOR'S NAME/COMPANY �'� e� Lic. No. 5 S `�� Class {� ,o {
Contractor's Address , Contractor's E-mail Address
/ J C "t
City )t5V Cr y State Zip Telephone Gj�f �� �LS 5
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT
SETBACKS RIGHT
PERMIT NO. ��7� C212� Z9 O
PLAN CHECK NO. `=�J
Ah
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $