HomeMy WebLinkAboutX2022-0142 - Permit Application (3)Print Form Worksheet for Combo Building & Solar Permit Application o
F Comm'I ('4�Residential City of Newport Beach - Building Division
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j5Auilding C Grading F Drainage f ElecI FMech F`
j— Plum Cu Yd Cutl Cu Yd Fill
Project Address (Not mailing address) F Flood F- Fire j` Liq F- Landslide FN/A Floor Suite No
Description of Work
Use ConstTypeF_
# Stories[— # Units (if Res)[—
r
_
`
Valuation $
Material/Labor
New/Add SF F_ Remodel SF�—
Garage/New/Add �—
OWNER'S NAME Last F
First
Owner's Address
Owner's E-mail Address
City State —ZiP F_ Telephonef�
APPLICANT'S NAME Last
Applicant's Address
Applicant's E-mail Address
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city S> �;!+�(�.tj_. State
Zip O/G"�-S� Telephone `� S`�c.�C� (t{ V
SC z
ARCHITECT/DESIGNER'S NAME
Last F� First �� Lic. F—
No.
Architect/Designer's Address
ArchitecUDesigner's E-mail Address
City [� State ��
Zip F_ Telephone��
ENGINEER'S NAME Last F�
First F_ Lic. No.F—
Engineer's Address
Engineer's E-mail Address
City F` � State
Zip � Telephone F—
CONTRACTOR'S NAME/COMPANY ��
q SL L Lic. No. ' 7
A'r L�C c 5 } G%Class
Contractor's Address
Contractor's E-'mail Address
City S'L ('� �-- ( L_ State
Zip Telephone < L'
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $