HomeMy WebLinkAboutPV2022-025 - Permit ApplicationPrint Form Worksheet for Combo Building $ Solar PermiEpp iicaotit5
F Comm"�, Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F-IBuilding F,Grading rDrainage [Flet Meth
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Project Address (Not mailing address) [i Flood
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r Fire F, Liq n Landslide FIN/A Floor Suite No
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Description o Work
Use Const Type __I
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Ineoh4GNIA Of(�f 16{J !110'0 C y� f0`<.ln/
# StoriesFj # Units (if Res)
Valuation $ �l ?3?—
Material/Labor vv/
New/Add SFF___ _7 Remodel SFF777777Garage/New/AddF
OWNER'S NAME Last— First
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Owner's Address
Owner's E-mail Address
City [G5,Mno, 'DLA O)o,( __-------]State �- -I
Zi I Telephone
APPLICANT'S NAME Last (�jp�tn�Gq
-- l First
Applicant's Address
Applicant's E-mail Address
City e State
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U� 6- up -1 Zip
(J� Telephone C
ARCHITECT/DESIGNER'S NAME Last
First �- Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City State Zip I Telephone
ENGINEER'S NAME Last
First Lic. No.7_77
Engineer's Address
Engineer's E-mail Address
City State Zip Telephoned;
CONTRACTOR'S NAME/COMPANY Lic. No ii)�gao Class GIS 13 G31
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Contractor's Address
Contractor's E-mail Address
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a� m�hvers'l�
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W_( lM� - State Zip
Telephone
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SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
PERMIT NO.
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $