HomeMy WebLinkAboutXR2022-1859 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Perm' Application
City of Newport Beach - Building Division ' 7Q 1
j- Comm'I Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
LIc00.NY
17 Building F_ Grading f—Drainage F_Elec F_Mech F Plum CuYdCut CuYdFill F
Project Address (Not mailing address) F_ F_ Fire F_ Liq j— Landslide F_N/A Floor Suite No
Description of Work
Use �3_V Const Type V-,;
# Stories # Units (if Res)F
0 I ey\Akho, pZAV(OOwKS
yevoV Atoh 4 �,X(S Tlr°� U11c�1(� /<�'q�c \aV�c1 Yo1
Valuation $
Material/Labor �A�c_ _,
New/Add SF1. N Remodel SF�—� Garage/New/Add
OWNER'S NAME Last I 'PgYtk �4 First �tV0V V(1q
Owner's Address Owner's E-mail Address
W ",456 r 2,w
City V' w" U✓'k ��k,� State I Zip -_`7ZG(7 Telephone 3ZS-6S
APPLICANT'S NAME Last yUyFirst S
Applicant's Address Applicant's E-mail Address
S3 W L% nco �K
Citync� ire 11M _ State Zip 9Z8(jS Telephone
ARCHITECT/DESIGNER'S NAME Last Jaya First SLa(/ Lic. No.
J
Architect/Designer's Address 1W �`
l )architect/Designer's E-mail Address
IA
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City State Zip I US Telephone :T vq — Zjq _ 1 Z-14-
ENGINEER'S NAME Last �t`�LtL, First JJUh Lic. No. (, °o}(CL6
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Engineer's Address Engineer's E-mail Address
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City State Zip Telephone qI _'Too,_ U b5
CONTRACTOR'S NAME/COMPANY Lic. No. �— Class
Contractor's Address Contractor's E-mail Address
City F State F Zip F Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO.�g�s,,
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. �� ���• 7/v
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
CITY OF NEWPORT BEACH
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
www.newportbeachca.gov 1 (949) 644-3200
INTAKE FORM � 3 e o
DATE:
7 O - n
NAME:
�-LM
n -L
PHONE NUMBER:
-1 `q _ `5 $6 _ 23 tO
EMAIL:
`wt � �cCOLSIC�V� S C 0r4
ADDRESS:
7 �/i/L �So r-
�4 7�r/ihe,-. re-*,s/�'Ln i�� Sri
SCOPE OF WORK:
22 q`,7
PC# (IF
APPLICABLE):
HOURS: PLAN CHECKER:
-11
PLNG: C4 AP ❑ N/A ❑ s C N (
BLDG: CO9 AP ❑ N/A ❑
DEPARTMENTS:
Pw: CO❑ APE] N/A ❑
EMP: CO ❑ AP ❑ N/A ❑
GRDG: COD AP❑ N/A ❑
FIRE: COI] APE] N/A ❑
OTHER: