HomeMy WebLinkAboutXR2022-2147 - Permit ApplicationPrint Form Workshoot for Combo Building & Solar Permit Applicaidon,
F Comm'I F_ Residential City of Newport Beach - Building Division#,Ul? -,4
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F-Building f- Grading [-Drainage f- Elec F_ Mech F plum
Project Address (Not mailing address) F7 Flood F_ Fire F_ Liq
2,11-11 /�'/f >,.fIlvlzZ
Description of Work
I / do�5
Cu Yd Cut r
Cu Yd Fill
I— Landslide F7N/A Floor Suite No
Use Const Type F
# Stories # Units (if Res)F
..... . . . . .......... ....
New/Add SF Remodel SF Garage/New/Add Valuation $ bor ....... .... . ... .... Material/Labor
OWNER'S NAME Last First
Owner's Address
Owner's E-mail Address
- - ------ ---------------- ...... ......... .. --- ----- --- - ------ - --------
City State Zip Telephonel . . .. .....
APPLICANT'S NAME
Last First
Applicant's Address . .... .
Applicant's E-mail Address
..... . .... . ...... ....... ... . ..... 60 --L7
........ ... . . ........ - keCity vA41 State
Zp Telephone
---------
.. . .... . ... ..... - . .........
.......
ARCHITECT/DESIGNER'S NAME Last First
AI � -Mb-VAE. Lic. No.
rch itect/Des! g n er's AddressF
00,>-�-_ -7-77 Architect/Designer's E-mail Address
- ------- . ......
City
7— 13>Ctate Zip
... . ....... STelephone
ENGINEER'S NAME Last foAl First Lic. No.
—
Engineer's Address Engineer's E-mail Address
--------------- ..... .....
- ----------
City State Zip Telephone
CONTRACTOR'S NAME/COMPANY r-6', Lic. No. — Class
. .. .......... . .... .... ... . .... ..
Contractor's Address Contractor's E-mail Address
/I Y-77 5_-T� 2 &_�- -
.. . ...... . - -Z7
City State [_ Zip
...... ...... . ..... . ...... Telephonel,�',/,F- 71 J-- -
SETBACKS REAR
SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT
USE ZONE
SETBACKS RIGHT
DEVELOPMENT NO
PLAN CHECK NO.
PLAN CHECK FEES $