HomeMy WebLinkAboutX2021-3028 - Permit ApplicationL Print Form j Work et for Combo Building & Solar Permit Application 02,
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Comm'I Residential ? City of Newport Beach -Building Division U( %LV LI ,�'Z�
NOTE: PLAN CHECK FEES DUE AT TIME OF SUB L `
Building Grading F-Drainage rElec r-Mach
a Plym Cu Yd Cutl Cu Yd Fill
Project Address (Not mailing address) C Flocild Fir Liq F Landqlirlp A r_N/A Floor Suite No
22 7 /Evs,%/p./C4-
of Work
ConstTypeDescription
Use C
# Sto# Units (if Ret
APP ALwF 7- /6ry *�
YV - :C A T/aL a A
N�S7 4ncv/vF Ta 4-
New/A did SFF— Remodel SF� Garage/New/Add �—
Valuation$
Material/Labor w�
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OWNER'S NAME Last First
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Owner's Address Owner's E-mail Address
City l ltwpoirT 15EACff State C q Zip gTelephoneF—
APPLICANT'S NAME Last �J
7�.. First
Applicant's Address Applicant's E-mail Address
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City -
State C�.. Zip vGO.. Telephone %�%` _ rd 7 - �j`/<--
ARCHITECT/DESIGNER'S NAME Last First 6#SP7,1A / Lic. No.
ArchitectMesigner's Address Architect/Designer's E-mail Address
'T. -57 77 ._ s u• ,�z o.---' aLc J44,p;�7f7,A� T
City State Zip Fc Telephone99,P19�f/{_�
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ENGINEER'SNAME Last First LiNo. �T � SS/� ftp
Engineer's Address Engineer's E-mail Address
31, > sa CAASj y
City q,„/i- State �Cft Zip /q �7� Telephone y,Q —Czs:-y
CONTRACTOR'S NAME/COMPANY ` Class
Lic No. 6 �r� /
Contractor's Address J Contractor's E-mail Address
City i State F717 '
Zip ZU ) Telephoner
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT �} PLAN CHECK NO.
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USE ZONE DEVELOPMENT NO �^(y! ` "
�PLAN
a CHECK FEES $