HomeMy WebLinkAboutXR2022-3162 - Permit ApplicationPrint Form' Worksheet for Combo Building & Solar Permit Application
r Comm'] r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding r Grading rDrainage rElec rMech r Plum CuvdCut F_ CuvdFill F_',.
Project Addresl/s (Not mailing address) r Flood r Fire r Liq r Landslide rN/A Floor Suite No
Description of Work
Use I Const Type F
0. 6Q. ' d o (ti\fr,( w
� o �Nl \W va
r—,
#Stories #Units (if Res)
{IDMvi,( 1(-_C
Valuation - �(ti _�� -
Material/Laa bor �
New/Add SF�—', Remodel SF F Garage/New/Add �
OWNER'S NAME Last M A4 e V\ First
Owner's Address Owner's E-mail Address
b c.'f re, Gan
City �,r.youe RAC State F Zip F_ Telephone (/
APPLICANT'S NAME Last �\ jijY\ First J
Applicant's Address Applicant's E-mail Address
s �(
GtP(AvI. U` *rfnn
City I Le,� State I (r ' Zip F%,C' ) Telephone Fi4 c) 3`5-t I
ARCHITECT/DESIGNER'S NAME Last First FJ Lic. No.
Architect/Designees Address ArchitecUDesigner's E-mail Address
City State �— Zip r— Telephoned
ENGINEER'S NAME Last bl AA 01 First (/ Lic. No. q
Engineer's Address Engineer's E-mail Address
City %VV(GA,b`u State Vq. Zip z`�"Sb_T Telephone 3-ytaD
CONTRACTOR'S NAME/COMPANY Cj _Oro \ C l(� Lic. No. 51N 6q Class'
/ T 'Jontractor's
Contractor's Address E-mail Address
'706 _ ,figs s:
.City
0_� State C-A7 Zip _ lZ12b 7 Telephone -7�(�.-Z00 ' �✓_'�l ___ . -___:.
/[1 G / YJ i2
y _ 1
SETBACKS REAR SETBACKS FRONT PERMIT NO. %INN �i121.oZa,3162
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. 'Q(�g,Q12,%J02gj
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $