HomeMy WebLinkAboutX2021-0016 - Permit ApplicationPrint Form Works ', -et for Combo Building & Solar Permit Application
( "Residential City of Newport Beach - Building Division
UNIT
NOTE: PLAN CHECK FEES
DUE AT TIME OF SUBMITTAL
Building FX Grading r Drainage JElec Mech
Plum cuvdCut Cuv Fin
Project Address (Not mailing address) r Flood
F_ Fire I— Liq j _ Landslide /A Floor Suite No
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Description of Work
Use R-5 Const Type N b
# Stories? # Units (if Res)
j N 1 . r'��uti1UC7r v ��1C`, ���-i 1 � � `��('��' �7� : �I.EVl�(�
IM.Sul iTr r G, eyf M . K(l.. �Iatiq?,5'%W&DOV'Js
Valuation i
Material/Laa bor
+
New/Add SF I Remodel SF I � 'I% Garage/New/Add
OWNER'S NAME Last
First CJ1 .1(-A
Owner's Address
Owner's E-mail Address
City State I
Zip �� Telephone 32<7/,
APPLICANT'S NAME Last ��� ,
First
Applicant's Address
Applicant's E-mail Address
City State F.--____
Zip �� Telephoned
ARCHITECT/DESIGNER'S NAME Last Vv+�� First �� Lic. No. .�,3
Architect/Designe�r.'s
Architect/Designer's E-mail Address
1Address
State
City v�i�'��'��� (' Lc`i'�ri �
Zi / Tele hone G
P/ P � \q,gzi(�. SK�7 '1
ENGINEER'S NAME Last( Y
First I T2�M Lic. No. F>oEU
Engineer's Address
Engineer's E-mail Address
--_- __-_-- —-
City State
I r .
Zip Telep hone ^^�
CONTRACTOR'S NAME/COMPANY Z W t _ ��
1G Lic No. 3 ?6-7Z2- Class
Contractor's Address
Contractors E-mail Address
S4,
City �r, 1��ti State C�A
Zip � Telephone 914
SETBACKS REAR 5 SETBACKS FRONT
PERMIT NO. / 02�` " YAn `
SETBACKS LEFT SETBACKS RIGHT -�
S PLAN CHECK NO. t,�lA ^�G-(
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $
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