HomeMy WebLinkAboutX2022-0004 - Permit Application (2)7-02Z—UUoLf
-Pnnt orksheet for Combo Building & Solar Permit Application
Comm'I (— Residential CT 00 ��2 d22 City of Newport Beach - Building Division rU2 i
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL RO pUN!16N
rBuilding [7 Grading rDrainage rElec rMech rPlum CU yd
Address (Not mailing address) ❑Flood ❑ Firer Liq r Landslide
Description of Work
F)
Cu Yd Fill 17
CN/A�Floor Suite No
I------
Use n Const Type
# Stories? # Units (if Res)[7
Valuation $ 3� x —
New/Add SF�j Remodel SF�i Garage/New/Add �� Imaterial/Laborl 1cou
OWNER'S NAME Last I � / ILIA //_ 1 First
Owner's Address Owner's E-mail Address
City pyl State Te
APPLICANT'S NAME Last I a -,L,-j7 I First
City
Address Applicant's E-mail Address
State Zip
9�,02r
ARCHITECT/DESIGNER'S NAME Last �— First
Lic. No.
Architect/Designer's Address
i
City J State
Architect/Designer's E-mail Address
i
Zip F— Telephone
—
ENGINEER'S NAME Last! f
,First I Lic. No.
Engineer's Address
City �— State
Engineer's E-mail Address
J
Zip L 1 Telephone
CONTRACTOR'S NAME/COMPANY Lic. No. - 635-661 Class
Contractor's Address
City.---- - ---- - State
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
Contractor's E-mail Address
Zip LTelephone
PERMIT NO. ?r,20 -ZZ _0L)0 4
PLAN CHECK NO. Q DG S - ZO2 Z
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $