HomeMy WebLinkAboutXC2022-1962 - Permit ApplicationPrint Form
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Worksheet for Combo Building & Solar Permit Application
j— Residential City of Newport Beach -Building Division �LC�' a�
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
(`Building j—Grading F-Drainage F_Elec r"Mech [;Plum CuYdCut l CuYdFill
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Project Address (Not mailing address) li Flood Fire (- Liq r Landslide _N/A Floor Suite No
3 - F_
Description of Work e W ,r -L ( ,!
FT
Use Const Type F
/MRL.8
# Stories #Units (if Res)
f
Valuation $
Material/Labor J'<�
New/Add SF�`�'� Remodel SF j�
Garage/New/Add
OWNER'S NAME Last � ���, .�
First
Owner's Address
Owner's E-mail Address
fur old lue6 yd'--74 A1Lct-
. �—
City I State FFA
Zip Telephone[
APPLICANT'S NAME Last ,
First �.
Applicant's Address
Applicant's E-mail Address
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City b State
Zip �Z�pTelephone
A, /DESIGNS S NAME '� -�-
�' Lash f.(, First Lic. No.
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Architect/Designer's Address
Architect/Designer's E-mail Address
cityState,-
ZipTelephone
ENGINEER'S NAME Last
First � Lic. NoF
Engineer's Address
Engineer's E-mail Address
City State
Telephone)
CONTRACTOR'S NAME/COMPANY
Lic. No. Class F
Contractor's Address
Contractor's E-mail Address
city % j�J State II
Zip k"3 Telephone
SETBACKS REAR SETBACKS FRONT
SETBACKS RIGHT
PERMIT NO. �*
CHECK NO.
LEFT SETBACKS
PLAN
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $