HomeMy WebLinkAboutX2022-0817 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
F-] Comm'I ff Residential City of Newport Beach -Building Division X11022- 1�V D'1,
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
CBuilding ❑ Grading FDrainage ❑ Elec [ Mech n Plum Cu Yd Cut iCuvd Fill L7 _7
Project Address (Not mailing address) ❑ Flood(—, Fire Liq F_ Landslide EN/A Floor Suite No
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Description of Work
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Use F_1 Const Type
# Stories17 # Units (if Res)n
Valuation S 12 �0
New/AddSFF Remodel SF� Garage/New/Add 3 � Material/Labor
OWNER'S NAME Last
First
Owner's Address
Owner's E-mail Address
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City I_ —— ---
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APPLICANT'S NAME Last (1- J First
Applicant's Address
Applicant's E-mail Address
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City-�-
State Zip Telephone
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ARCHITECT/DESIGNER'S NAME
Last First[ Lic. No.
_ -Lic.
Addres�sj
Architect/Designer's E-mail Address
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City State Zip �G ��- 1 Telephone -- --
' �Last
ENGINEER'S NAME �I
i FirstY Lic. No. — 1
Engineer's Address
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Engineer's E-mail Address C —
City r-- --
tate Zip Telephone
CONTRACTOR'S NAMEKOMPANY Lic. No. � 0_ Class
Contractor's Address Contractor's E-mail Address Lb i
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City i State Zips `7�.� Telephoned
SETBACKS REAR SETBACKS FRONT PERMIT NO. (/
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.(JE
4.
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USE ZONE DEVELOPMENT NO VA IPLAN CHECK FEES $ �/�F