HomeMy WebLinkAboutXC2022-2073 - Permit Application1- print Form __Worksheet for Combo Builtling & Solar Permit Application
r Comm'I F_ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAI
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Building [ Grading F-Drainage r"Elec Mach F- Plum Cu Yd Cut F_
Cu Yd RH F_
Project Address (Not mailing address) F_ Flood r Fire r_ Liq r Landslide FN/A Floor Suite No
Description of Work
l`$(\4-- ��) 111 !� �p(y Use ConstType�
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# Stories #Units (if Res)
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Valuation $ Ff
New/Add SFF—Remodel SFGarage/New/Add�Material/Labor1500
OWNER'S NAME Last u i A! r C 0 First liq f q
Owner's Address Owner's E-mail Address
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city I r
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pJe f%fl Q ��1 State I vrAi- zip L� T�eleyphone `ir'f°1200 °rlo()
APPLICANT'S NAME Last n First 011
Applicant's Address Applicant's E-mail Address
IS6"�_Creeh_ 4¢I �.Ie �05 {rvla a (ic51C,nS boy,
city�B'T �NkOrC-c'5 State F(!F -
I�6Zip �(2(J?(_1, Telephon 760)-ts-`t-1 C,
ARCHITECT/DESIGNER'S NAME Last First —
Lic. No. F_
Architect/Designer's Address Architect/Designer's E-mail Address
City State �— Zip Telephone�—
ENGINEER'S NAME Last First Lic. No.��
Engineer's Address Engineer's E-mail Address
City State Zip F— Telephoner
CONTRACTOR'S NAME/COMPANY n „ C� ! Lic. No. Class C c
Contractor's Address ' " l Contractors E-mail Address
Shtie-ti- s� t—e C o d LL
City t�tA/,s 605 State cG Zip CI Z0?b TelephofeF71 )CO�r1-l(1�
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $