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X2021-1603 - Permit Application
Print Form % r Comm'I K Residential �jBuilding r Grading Project Address (N t© of Work W ;die for Combo Building & Solar Permit Application City of Newport Beach - Building Division NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL inage Elec ech r plum Cuydcut— Cu `Gd Fill mailing address) F- Flood j` Fire F" Liq r Landslide EL* 01Af<q Z6aR5r 1ZI_�_M6-0 i—=—L P,2r'-Fait New/Add SF 11 p�+iiodel SF F — Garage/New/Add �— OWNER'S NAME LastL�� Owner's Address r City =—i/J <:58 State �— APPLICANT'S NAME Last Applicant's Address ?-i t1nGT—({A city ARCHITECT/DESIGNER'S NAME Last Architect/Designer's Address First I M A-V-J< Floor Suite No .I 1 F - Use ConstTypel I # StoriesFT # Units (if Res)F— Valuation Material/Laa bor ; Owner's E-mail Address M✓At 1ctA6�_�sMmy- Zip �2k,5� Telephone � T ( S Zct 5 First I -F- I. C K Applicant's E-mail Address Ti '4 t A 43 + @ A -a State Rj.- zip F9 36 Telephone e?4 —633 -73 z5 First I Lic. No. F_ Architect/Designer's E-mail Address City I State r— Zip [_ TelephoneF� ENGINEER'SNAME Last 2 /Z AVTK Y First YJ iz Lic. No. Engineer's Address (f�Z Engineer's E-mail Address I Sao -0 d v� �� , 4� a City �fPU�( �jC�( State �— Zip R(:236 Telephone 4'45_5S3) �-s;5 CONTRACTOR'S NAME/COMPANY - -- Lic. No. F_ Class Contractor's Address _ _ Contractor's E-mail Address City I State F— Zip F_ Telephone[� SETBACKS REAR SETBACKS FRONT `" PERMIT NO. SETBACKS LEFT SETBACKS RIGHT PLAN CHECK N0. USE ZONE DEVELOPMENT NO PLAN CHECK FEES $