HomeMy WebLinkAboutX2021-1106 - Permit ApplicationPrint Form W she for Combo Building & Solar Permit Application
j- Comm'I ly Residential x City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL �� a�•'
FV,Building r- Grading
Drainage j- Elec r Mech
Xplum Cu vd Cut F_Cu Yd Fill F
Project Address (Not mailing address) F_ Flood
j- Fire r Liq F_ Landslide F_N/A Floor Suite No
F�Xf_N e
WF_VJPeR—) (DAP
Ck 92 654 1 1
Description of Work
O!fRON
lif
Use Const Type
Q!r=ff �99
tories #Units (if Re ,
Valuation $
Material/Labo
New/Add SFF_ Remodel SF17
�Z 20 Garage/New/Add F
OWNER'S NAME
Last I 1-16�4Aaiy
First 1T09
Owner's Address
Owner's E-mail Address
M FkY'rrIC&
eaR,�- Cm>—k
City N F \U0R"V CM-1- State I U-
Zip _• 2( TelephoneF
APPLICANT'S NAME
Last t�C
First �
, 1 v>2s�igcNt
Applicant's Address
Applicant's E-mail Address
City � "'In �,;�
State
Q
Zip 26C) b Telephone � y 'L�� 36
7
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State F__
Zip F_— TelephoneF—
ENGINEER'S NAME
Last
First Lic.. No.
Engineer's Address
Engineer's E-mail Address v
City
State F__
Zip F— Telephoned
CONTRACTOR'S NAME/COMPANY 1 / I 1, ��-�o of a-q Lic. No. 1*0�class W
Vt- P 6
Contractors Address
Contractor's E-mail Address 0 -22
12256 V V-f A (�U dZ` "
City I KVAW,�i -A--
State I
Zip �2 06 Telephone j/y T b o JTCr
SETBACKS REAR
SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $