HomeMy WebLinkAboutX2022-1553 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application off RA\m
- Comm'I 7/Residential of Newport Beach - Building Division o !_
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL `` u
F uilding r Grading
F-Drainage F�Elec r Mech
F>/Plum Cu vd Cut F_Cu Vd Fill F_
Project Address (Not mailing address) F_ Flood
(- Fire F_ Liq r Landslide F_N/A Floor Suite No
v8 8t /609
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Description of Work
Use Const Type 1/d
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# Stories #Units (if Res)r—
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Valuation 2 0 ��
Material/Labor J /
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New/Add SF yZd Remodel SF 2SI 2 Garage/New/Add �
OWNER'S NAME
Last i cP
First I e",.t
Owner's Address
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Owners E-mail Address
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City ,�/cw o l tJc.cry State ��
Zip 9266 j Telephone (6/f> y/j, ,362y
APPLICANT'S NAME
Last /e / /f
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First e /
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Applicant's Address
Applicant's E-maidress
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City G<r�n �sraK
State cq
Zip y2�y/ Telephone 9,31-v9y-z.��t
ARCHITECT/DESIGNER'S NAME Last �� First Lic. No.
Architect/Designers Address
Architect/Designer's E-mail Address
City
State I
Zip F_ Telephoned
ENGINEER'S NAME
Last �%/� <�
First �<� Lic.No.l (6�739
Engineer's Address
Engineer's E-mail Address
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City [6.,
State v�
Zip 24YJ03 Telephone y3y_,j�y_2J.y
CONTRACTOR'S NAME/COMPANY Lic. No. / p0_T1 Class
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Contractor's Address
Contractor's E-mail Address
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City /Z, �e.. w.
State c-A
Zip F1260. Telephone �/
'3-.02 7
SETBACKS REAR
wc4<7TBACKS FRONT
PERMIT NO.
SETBACKS LEFT
q SETBACKS RIGHT L/
PLAN CHECK NO. y/ 73
USEZONE
DEVELOPMENT NO
PLAN CHECK FEES $