HomeMy WebLinkAboutX2022-0915 - Permit Application„SI?nnt Form_ '� Worksheet for Combo Building & Solar Per ViAnnlicatiz
[7;Comm'I [ Residential City of Newport Beach - Building DivisionU_
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
❑Building ❑Grading ❑Drainage ❑Flet ❑Meth E] Plum cu vd CutF— Cu Yd Fills
Project Address (Not mailing address) [1 Flood ❑ Fire ❑ Liq
❑ Landslide [N/A Floor Suite No
Description of Work
Use F-1 Const Type
R
/ZEr..,ov.G/1 S 1 k���9�
# Stories # Units (if Res)❑
Valuation $
Material/Labor G U
New/Add SFRemodel SF �� Garage/New/Add
OWNER'S NAME Last Y� �� First
Owner's Address Owner's E-mail Address
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City ��G/(i %JO State Zip
Telephon / 0 %37
APPLICANT'S NAME Last el -,f 61 q yj First
Applicant's Address Applicant's E-mail Address
City State Zip 2
Telephon q
ARCHITECT/DESIGNER'S NAME Last First
�5� Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State ZIP
TelephoneL—
ENGINEER'S NAME Last First F-7-71 Lic. No.��
Engineer's Address Engineer's E-mail Address
City State Zip F-71
TelephoneF7
CONTRACTOR'S NAME/COMPANY /J
H
h Lic. No. �i� _. ,C( Class G y7
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Contractor's Address (� Contractor's E-
ail Address
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City �n State �%� Zip
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Telephone Qv ��
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SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $