HomeMy WebLinkAboutX2022-0576 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application oF�`�°°aa
Omm'I residential City of Newport Beach - Building Division ��((
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL` 5�.ow,.�'
wilding F_ Grading rDrainage rElec rMech F- Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) r Flood r Fire r Liq r Landslide rN/A Floor Suite No
FWf a �/3
Description of Work e LAG d S
Use(,ConstType V A
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6/'' ���f/ '%�ti��, n % AZI), as/ G� 113?
# Stories', # Units (if Res)
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Material/Labor ww-
---Valuations
New/Add SF f g
OWNER'S NAME Last /�L j�/�{✓� First
Owner's Address Owner's E-mail Address
city State Zip F777777 Telephone�—
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APPLICANT'S NAME Last -7i-vx x First A
Applicant's Address Applicant's E-mail Address
Zv//�_ IIA A6vAit. /1vf- oG /1Vak
City 4A,0 4 a,�wD State F(�j Zip Telephone
ARCHITECT/DESIGNER'S NAME Last / "/l A/ /'fit / First A,/L d Lj Lic. 1\14. -
ArchitecUDesigner's Address Architect/Designees E-mail Addrests
City _. �.. State r Zip F— Telephone
ENGINEER'S NAME Last First ' . No f
Engineer's Address Engineer's E-mail Ad r s
city State F_ Zip Telephoned\
CONTRACTOR'S NAME/COMPANY rV n /r�101XII )RWC)VC4i2/1 241c- Lic. No. ' SG7cj3 ClassF
Contractor's Address Contractor's E-mail Address
15650 e 1 f„c,dv and h 1aMona I tr ovC,ra /wa CoM
City cor ^b _.... _.. State FC/4” ZipF1717),0 Telephone X151-275"1(io
SETBACKS REAR SETBACKS FRONT PERMIT N0, 6
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $