HomeMy WebLinkAboutXC2022-1948 - Permit ApplicationL print Form Worksheet for Combo Building &z Solar Permit Application
j— CommI (W Residential
City of Newport Beach - Building Division 4v1,10
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building jY Grading f—Drainage [_ Elec F Mech f- Plum Cu Yd Cut Cu Yd Fill
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Project Address (Not mailing address) F_ Flood F_ Fire F7 Liq F_ Landslide F_N/A Floor
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Description of Work
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New/Add SF�O� Remodel SF� Garage/New/Add F�
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Suite No
Use F Const Type F-7
# Stories # Units (if Res)
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Valuation ` ,
Mated /Labor �L1 O
OWNER'S NAME G�Fi
/ /,C1r� 1c1C� ��� First
Owner's Address Owner's E-mail Address
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City _ �� . tJ ° 1VI State(' _�
- �_ %�_ _. Zip L LEA G1J Telephone
APPLICANT'S NAME Last
C e (b') f GA ) First
Applicant's Address Applicant's E-mail Address
F -7
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City f /c✓ d�" / State ` /- �, c
l..- (/ ►._-._ Zip �f G 6 Y Telephone�� , j. - 75�0
ARCHITECT/DESIGNER'S NAME Last
First Lic. No.
Arch itect/Designer's Address Architect/Designer's E-mail Address
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City State �— Zip �— Telephone
ENGINEER'S NAME LastC raft First G , ! Lic. No
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Engineer's Address Engineer's E-mail Address
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Cit r�/fin _
y _ �' State l Zip �A ' �f r Telephone �j�� �� 1�6)
CONTRACTOR'S NAME/COMPANY J ) '? Lic. No. ��S Class 7
Contractor's Address 4 f Contractor's E-mail Address
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ry(/� �'''� %�' CctiG State l'. /� Zip �P�S Telephone C4 •7Z L3 0 47
SETBACKS REAR
SETBACKSLEFT
SETBACKS FRONT
SETBACKS RIGHT
PERMIT NO. (j
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO _� PLAN CHECK FEES $