HomeMy WebLinkAboutX2022-0296 - Permit ApplicationXZvZ2-02°1(�
Print Form Worksheet for Combo Building & Solar Permit Application o�?EW�Ra
Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
W;- 96`ilding j_ Grading [-Drainage F� j- Mech j-� Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) F_ Flood F Fire [_ Liq F Landslide [-N/A Floor S�uiteeNNo�`
F 12::�j 5 P0 I
Description of Work
Use Const Type
!f
JAM
# Stories[— # Units (if Res)[ —
Valuation a
Material/Cabo E`A►1( �XJ
New/Add SF Remodel SF�_Garage/New/Add ��
OWNER'S NAME Last e First l
Owner's Address Owner's E-mail Address
I `�15
I I
City State F � Zip Telephone]
APPLICANT'S NAM Last 6- ,_ IN First ; V1 (awl
v ` wl
Applicant's Address Applicant's E-mail Address
47,-5,- -:�� `emu
I State �Kb-zip / Telephone
Cityy� P,�ftk 0��)
ARCHITECT/DE GNER'S NAME Last 6��� �-�� � First � j I� y�G'��` _ Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State Zip Telephone��
i„ � i i C.) First f Lic. No.
ENGINEER'S NAME Last /" J` -'f d 1
t
Engineer's Address Engineer's E-mail Address
�.,
City State Zip &17 Telephone 69i&
CONTRACTOR'S NAME/COMPANY ; ✓��" i ?1 Lic. No. ���� ��CIassF
Contractor's Address Contractor's E-mail Address
City State F Zip Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO.
RG
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $