HomeMy WebLinkAboutXR2022-2142 - Permit ApplicationPrint Form
a Worksheet for Combo Building & Solar Permit Application
r Comm'I r 6esidential City of Newport Beach - Building Division <� 12 `1,p22 -24,q Z
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F Building ( Grading [-Drainage f7Elec r Mech Plum cuYdCut
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Cu Yd Fill
Project Address (Not mailin
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Description of Work
New/Add SFF_ Remodel
F_ Flood F- Fire r- Liq r Landslide
New/Addarag
OWNER'SNAME Last
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Owner's Address
Owner's E-mail Address
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APPLICANT'S NAME Last (�✓ 1 yy , p
Applicant's Address
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City �n! /.
NY O State CL�
ARCHITECT/DESIGNER'S NAME
Last
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r_N/A Floor
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Suite No
Use Ff iz_ Const Type
# StoriesF— # Units (if Res)F
Valuation $
Material/Labor
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First L -A rL,o k YV
Applicant's E-mail Address J
Clic?4r'Nrf (od�� `J
Zip Telephone "Y t/ 31 ,
Lic. No. F—
Architect/Designer's Address --/ArchitecUDesigners E-mail Address
City
State �— Zip F— Telephone�—
First
ENGINEER'S NAME Last
First �! Lic. No.F—
Engineers Address Engineer's E-mail Address
City State �® �—
ZIP Telephone
CONTRACTOR'S NAME/COMPANY - _ ) p ftj� N Pa,c,, rr-r G %J, /v%e �$ Lic. No. 5�57 Class /�
Contractors Address Contractor's E-mail Address
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a v G/7�cN State C� ZiP 9 2[ %7 Telephone l
SETBACKS REAR 0/1 f0 v SETBACKS FRONT
SETBACKS LEFT I SETBACKS RIGHT
USE ZONE /
f DEVELOPMENT NO
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s 7 , -Z, HERMIT NO. /,.\rj - ZI Z
3 7 PLAN CHECK NO. PC UZ Z- 1182
PLAN CHECK FEES $