HomeMy WebLinkAboutXR2022-3354 - Permit Applicationaria Form ` ;) Worksheet for Combo Building & Solar Permit Application Cc 00-913-2Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIMF OF StIRMITTAI.
[Building [Grading [-.Drainage [Elec F-Mech FPlum cu yd cut F Qvd Fill
Project Address (Not mailing address) F_ Flood F- Fire F- Liq r Landslide [N/A Floor Suite No
Description of Work
Use ConstType�
n y'�- - M/ (. se r' tG .��re 1k,,,9 f
#Stories #Units (if Res)
Valuatio/
.Material/La orZ 0 e>I ! '
New/Add SF�— Remodel SF�- Garage/New/Add �
OWNER'S NAME Last LC Sa;N-*11_&�u'r� LLGFirst-
Owner's AddressOwner's E-mail Address
City 1Vj-5 t/n h{ t �/ - State tj Zip / 3 G 2 Telephone % 7.Z
APPLICANT'S NAME /� i
Last !/�^ First
Applicant's Address Applicant's E-mail Address
_- 5
City State C -- Zip , ! Z %bs Telephone 7(y-%27.. y/
ARCHITECT/DESIGNER'S NAME Last � ndjt First /l�i7c/1J`l Lic. No
Architect/Designees Address Architect7Designees E-mail Address
City State F— -Zip F7Telephone—
ENGINEER'S NAME Last First Lic. Nol_—
Engineer's Address Engineer's E-mail Address
- . _ ------- - _
City State Zip Telephone�—
CONTRACTOR'S NAME/COMPANY Li?LRec. No. (OZ73�g Class
Contractor's Address Contractor's E-mail Address
Z27% 5.. C7rWNc/ /j(/t ! `i�yelr� !1/ti'YGtf-,Bran -GD
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city Via ANG ..-_ - State C�— Zip . �2 Jp� Telephone 7/rj ..%Z7 ?75
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $