HomeMy WebLinkAboutX2022-0020 - Permit ApplicationOri 9 Xuatv?, vEWPo�
Print Form Worksheet for Combo Building & Solar Permit Applicat on
[ Comm'I [ Residential City of Newport Beach - Building Division o
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
wilding rGrading [Drainage [Elec [Mech r - Plum CuvdCut CuvdFill F
Project Address (Not mailing address) [ Flood [ Fire [ iq [ Landslide [N/A Floor Suite No
280a RRA'SHVREI N g ICA 4ja(4(08 on in 44 F
Description of Work( SES �iG OF RWLV:2$'t-i, J61N
Use I—ConstType F_
#Stories #Units (if Res)r—
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Valuation $
New/AddSFF.- Remodel SFF14ZO Garage/New/AddF_
Material/Labor 160,000
OWNER'S NAME Last PR� 5 1 First RL L_`0510,1
Owner's Address Owner's E-mail Address
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City I -W" �t'. _ P State f C -A -'... Zip ,��,, Telephone t q_8%icnz j
APPLICANT'S NAME Last e� C7Z First NiJ(ztW
Applicant's Address Applicant's E-mail Address
2855 _L' RaT coals H WY. tf Z-34 GoEi'z.A Rc H (!� EflRT44 L INK i NG 7'
City Q . j�.. _ .. State Zip .. Z ro Telephone -(4%3- j J 6?.
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State F-- Zip F_ Telephone[—
ENGINEER'S NAME Last ADL:TZ, First r Lic. No.F_
Engineer's Address Engineer's E-mail Address
City State F Zip �s TelephoneF
CONTRACTOR'S NAME/COMPANY ` r JJ I Lic. No. r Class
Contractor's Address Contractor's E-mail Address
City State F_ Zip Telephone.----_—.
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. 013 e
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USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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