HomeMy WebLinkAboutE2022-0212 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division 5 aVaa "�iaj�
r'' Comm'I Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
�Builcling I
Grading Drainage r' Elec j-- Mech F7 Plum Cu Yd cut Cu Yd Fill
Flood Fire Li Landslide j-N/A Floor
Project Address (Not mailing ad ress) i� L- � q C-
I//� C I ., ............................... . - _....,..1 . . ........ ...... . . ...... I
New/Add SF
OWNER'S NAME Last
Owner's Address `
city j%`�e.
Garage/New/Add I
First
Owner's E-mail Address
State- Zip
T
Suite No
Use F Const Type F
# Stories #Units (if Res)
Valuation $
Material/Labor
APPLICANT'S NAME Last S First
Applicant's Address Applicant's E-mail Address
O%1-� .-���'... ' ..._�. ......... ...�1'LC��C`11.. � �1. -a r��.1�r'�G�`�r
cit State ZipTele hon C
-,
ARCHITECT/DESIGNER'S NAME Last - First ��/f,/1 "q/,/ V
l / Lic. No. ! G'
Architect/Designer's Address Architect/Designer's E-mail Address
City State Zip Telephone
ENGINEER'S NAME Last /�` �r First i Lic. No.
Engineer's Address Engineer's E-mail Address
City State .� Zip / Telephone 77+
/
CONTRACTOR'S NAME/COMPANY I ILic. No. I p IV(, Class
Contractor's Address Contractor's E-mail Address
04
City �' State Zip Tele hone Q
qAt)
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SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT
USE ZONE
SETBACKS RIGHT
DEVELOPMENT NO
_11;�VT
N CHECK NO.
PLAN CHECK FEES $ "'�