HomeMy WebLinkAboutPV2022-034 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit A plication
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Comm'I F_Residential City of Newport Beach - Building DivisionNOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding r Grading j—Drainage F_Elec F_ Mech r Plum cuvdCut F Cu Yd Fill F
Project Address (Not mailing address) f- Flood f— Fire F_ Liq r Landslide [_N/A Floor Suite No
Description of Work
V l' a
Use F Const Type F
# Stories #Units (if Res)
16
to' ULM n
Valuation$
New/Add SFF__ Remodel SFF—
Garage/New/Add F—
Material/Labor
OWNER'S NAME Last
First
Owner's Address
Owner's E-mail Address
City State F Zip F—Telephone—
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City State r
Zip F—, Telephoned
ARCHITECT/DESIGNER'S NAME Last
First Lic. No.
Architect/Designer's Address
Architect/Designees E-mail Address
City State F_
Zip F—' Telephone
ENGINEER'S NAME Last
First f Lic. NoT
Engineer's Address
Engineer's E-mail Address
City _ State F_
Zip F— Telephoner
CONTRACTOR'S NAME/COMPANY (
D
Lic. No.F? W(-6 Class
Contractor's Address
Contractor's E-mail Address
2A'5L H
City 7yv rt State F
Zip Wt4� Telephone 'E &j - q
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $