HomeMy WebLinkAboutX2022-0839 - Permit Application (2)X2022 -0B 5q
Worksheet for Combo Building & Solar Permit Application
7 mm'l F- Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
uilding F-, Grading rDrainage ,7Eec _;4ech
F,11um Cu rd Cut Cu Yd Fill
Project Address (Not mailing address) F- Flood
f- Fire F- Liq FLandslide F -N/A Floor Suite No
5 NGo
i
Description of Work
Use [— Const Type
# Stories #Units (if Res)'
l
Valuation $
New/AddSFF RemodelSFFF Garage/New/Add Material/Labor
2
OWNER'S NAME Last /%sp, vrD(if
First
Owner's Address Owner's E-mail Address
N_ ..
—
City State F Zip F Telephone
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
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GGI Viz- 6,brj
City NL -9 RYL-T a� State I till Zipqi4;-q
Telephone
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ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designer's A dress
Architect/Designer's E-mail Address
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_
State 5) Zip ---yZ 6o Telephonef S �r-�io ?)D
City N1 7W n� 1'•""'�� 1 q
('I
ENGINEER'S NAME Last
First F Lic. No.
Engineer's Address
Engineer's E-mail Address
City State F Zip
Telephonel—
CONTRACTOR'S NAME/COMPANY
42-ntriptcjs
Lic No. ClassF
Contractor's Address PRO
E-mail Ad ess
City State �
1 kA Ff
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $