HomeMy WebLinkAboutX2022-0915 - Permit Application (2)Ptnt,Form Worksheet for Combo Building & Solar Per I Applicatio?m
Comm'I C Residential City of Newport Beach -Building Div !Sion
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL �<„o„r
CBuilding C Grading [Drainage C Elec Mech C Plum cu yd cutF— Cu Yd Fin
Project Address (Not mailing address) C Flood C Fire C Liq [7Landslide CN/A Floor Suite No
Description of Work
/1 7',l
Use F7Const Type
# Stories❑ # Units (if Res)F7
Valuation $
New/Add SF Remodel SF F77777 Garage/New/Add Material/Labor G (/
OWNER'S NAME Last yo r� I First I �/L/C I
Owner's Address Owner's E-mail Address
City `{*, State � Zip Telephon
APPLICANT'S NAME Last e,417( /7”) First A A-1�)
Applicant's Address Applicant's E-mail Address
41
City State Zip 22 Telephon v_d D1/j—
ARCHITECT/DESIGNER'S NAME Last First F777-71 Lic. No.
1-7-71
Architect/Designer's Address Architect/Designer's E-mail Address
City State Zip F7777 Telephoned
ENGINEER'S NAME Last1-71 First Lic. No.�
Engineer's Address Engineer's E-mail Address
City I State Zip �— Telephone[=
CONTRACTOR'S NAME/COMPANY h Lic. No. c Class 9
—317 Contractor's Address Contractor's E- ail Address e h
City State v I—J Zip Telephone
�Z
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
PERMIT NO.
PLAN CHECK NO. 0 c7 _ Qf
PLAN CHECK FEES $