HomeMy WebLinkAboutXR2022-3143 - Permit ApplicationPrins Form_ ___Worksheet for Combo Building & Solar Permit Application o s
F_ Comm'I F_ Residential City of Newport Beach - Building Division ��ZZOZZ �� ?
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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rBuilding F_Grading rDrainage F_Elec F_Mech F-Plum Cu Yd cut Cu Yd Fill
Project Address (Not mailing address) C Flood r- Fire j- Liq F_ Landslide F_N/A Floor Suite No
Description of Work
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Use �I Const Type v
Stories # Units (if Res)
Valuation $
Material/Labor �n
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New/Add SF -' Remodel SF �— Garage/New/Add
OWNER'S NAME Last Vjer, First ,�,c'� k
Owner's Address Owner's E-mail Address
City � &, 6 z,,, AC State l Zip 2 _ Telephone 5
APPLICANT'S NAME Last �First
Address 6-le, �G
Applicants Address Applicant's E-mail Address
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citY ` lh- _VjjzVZ_'f7 t,: � _ State �— p C a TelephoneFlzir L iiiW—
ARCHITECT/DESIGNER'S NAME Last 4jZTwe 4 �{ � , ( First F Lic. No. t✓ � �
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Architect/Designer's Address Architect/Designer's E-mail Address
City State F Zip F TelephoneF —
ENGINEER'S NAME LastFF C �1_1 U,6z I First r Lic No.F—
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Engineer's Address JL b�1, �i En ' eer's E-mail Address
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City �`V� ��[ State c__4�i , Zip Telephone N,4 ��� �✓L�vz3
CONTRACTOR'S NAME/COMPANY
01 kvtdLvv� ,E� f_. Q � C LhJ,�%Lic No. Class
Contractor's Address ' G�'L7 �t'Z� C(�
Contractor's E-mail Address �
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City L f c L)/j /n , State Zip I ZZ I TelephoneF// zz Q
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NS PLAN CHECK FEES $