HomeMy WebLinkAboutXR2022-3052 - Permit Application_ _Pr_nt Fo_rm Wot. rkfr sheet for Combo Bulldinh&Solar Permit Application
City City of Newport Beach Building Division Comm I F-, Rez"'x
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Building F_ Grading ra a e Elec F
� Ig � � Mech � Plum Cu Yd CutCu Yd Fill
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Project Address (Not mailing address) F_ Flood r Fire F- Liq Landslide [_N/A Floor Suite No
Description of Work
pem p Lis I, Us Const Type
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# Stori # Units (i
r V luation $�\r1i
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New/Add SF Remodel SF L - Garage/New/Add I ! aterial/Labdr OOo
OWNER'S NAME Last First l
Owner's Address (I Owner's E-mail Address
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City �� State
- Zip -- �� 6 Telephone
APPLICANT'S NAME Last First uu
Applicant's Address Applicant's E-mail Address
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City.{
..._ State _ Zip ._. .- Telephone
ARCHITECT/DESIGNER'S NAME Last
5J'll EH'I First SSr� Lic. No.
Architect/Designer's Address Arch itect/Designer's E-mail Address
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City State Zip Telephone
ENGINEER'S NAME Last
SALE Y,3 .._- First _...._Q iS e1r-_.... Lic. No. S 9.9,9_
Engineer's Address A�l1 Engineer's E-mail Address
City State Zip Telephone F_
CONTRACTOR'S NAME/COMPANY Lic. No. F_— Class
....._ . _. _...
Contractor's Address Contractor's E-mail Address
_._.._
City State Zip Telephonex4,OZ Zi��
SET BACKS REAR
SETBACKS FRONT
PERMIT NO.
SETBACKSLEFT
USE ZONE
SETBACKS RIGHT
DEVELOPMENT NO
PLAN CHECK NO.
PLAN CHECK UES
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