HomeMy WebLinkAboutXR2022-3008 - Permit ApplicationPnnt Form Worksheet for Combo Building & Solar Permit Application swpo
Comm'I Residential City of Newport Beach - Building Division �� i
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMIT LZ�22
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Building [ Grading [—Drainage F_ Elec F_ Mech Plum Cu Yd Cut F_
Cu Yd Fill
Project Address (Not mailing address) (- Flood F- Fire F_ Liq F_ Landslide I_N/A Floor Suite No
F-L37- j(�1_,,_Vi_> ...... ......
Description of Work
/mac- f' r +o t-jtD. ir--- T OF (C-) F/(.2,sT-1v1�
New/Add SF Remodel SF Garage/New/Add F-
OWNER'S NAME Last J
lVTG6�� . -- ......._ First --f 1
Use F Const Type F
# StoriesF_ # Units (if Res)F—
Valuation $
(9
Material/Labor
Owner's Address Owner's E-mail Address
......_ 1
y ���D- - .._' State
City -
G Zip ':1 Z�p:j 7_Telephone
_ _-.__.._._------ _
Architect/Designer's Addres�ss Architect/Designer's E-mail Address
City �'j State Zip l-'7-Al-e7 Telephone -7(t �
ENGINEER'S NAME Last G� f First Lic. No],,,,-�37
... _.... .. .. - --_._
Engineer's Address Engineer's E-mail Address
161
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City , State ZipTelephone _ ..... _... - p Z r,6
CONTRACTOR'S NAME/COMPANY C'_IS S Co h '� i 0 n t Lic. No. 't3 D'� `� Class
Yi ens
-:
Contractor's Address Contractor's E-mail Address
_ __ s--QY v,r
City _ t2�' (+ J\.........__ _ State e Zip a� � Telephone
SETBACKS REAR
SETBACKS FRONT
1-)/�/ $ to
PERMIT NO
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
PLAN CHECK NO. W T� /1)
PLAN CHECK FEES $