HomeMy WebLinkAboutXR2022-3158 - Permit ApplicationI Print Form j Worksheet for Combo Building & Solar Permit Ap . plication'
[P-Comm'l 0esidential
City of Newport Beach -Building Division
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMI'FTA
[.`Building r— Grading F-Drainage F7 Elec F_ Mech Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) F_ Flood r Fire F7 Liq F_ Landslide F_N/A Floor Suite No
Description of Work ellAl Petl
Use Const Type
Oro
#Stories177 # Units (if Res)
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Valuation $
Material/Labor
New/Add SFF �F[
el Garage/New/Add F
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OWNER'S NAME Last 112-e- First
Owner's Address Owner's E-m.all.Addregs
City F State Zip Telephone
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
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City ),Aj'1?-_>0A A-)t /lIV-11D State Zip Telephone -2
ARCHITECT/DESIGNER'S NAME Last First A/V Lic. N(.'*'I,- 2
Architect/Designer's Address Arch itect/Designer's E-mail Address
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C ity 'State Zip Telephone
ENGINEER'S NAME Last FirstF Lic. No.l.
Engineer's Address Engineer's E-mail Address
City F State F_ Zip F TelephoneF
CONTRACTOR'S NAME/COMPANY Lic. No. (10 ClassF
Contractor's Address Co�nractor's E-mail Address
City State F_ Zip TelephoneF
SETBACKS REAR SETBACKS FRONT PERMIT NO. Out?, _wK
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. 1(," 0
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $