HomeMy WebLinkAboutM2022-0050 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application 1 , -
(— Comm'I FResidential City of Newport Beach - Building Division ��
NOTE: PLAN CHECK FEES DUE AT TIME OF SU d
[Building F- Grading F—Drainage F- Elec F—Mech f— Plum CuYd y
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HARBII �RMIT
Project Address (Not mailing address) F Flood F— Fire F Liq F— Landslide N/A Floor Suite N
Description of Work
Use F Const Type F
#Stories #Units (if Res)
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G�`�y�� 1�
New/Add SF�— Remodel SF Garage/New/Add I r
Valuation $
Material/Labor �(�U00
OWNER'S NAME Last ;�� First
Owners Address Owner's E-mail Address ll
City ' V�UL ._ . State F— -
ZipFTelephone � GE47jI
APPLICANT'S NAME Last 1 T �- �s First j/�Cq_
l
Applicant's Address
Applicant's E-mail Address
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City ��h-lf^n `:,l 'Y` State FCA Zip l%J J � Telephone
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ARCHITECT/DESIGNER'S NAME Last First 7—Lic. No. �--
Architect/Designer's Address Architect/Designer's E-mail Address
City State �— Zip �— Telephoner
ENGINEER'S NAME Last / V First P .f� 1Y�1�
U (C' Lic. No.
Engineer's Address Engineers E-mail Address
Gt I � ���I� i '!
cL'! I / , l
City ��(��u��� N I State Zip 1 V_T Telep n 11
CONTRACTOR'S NAME/COMPANY sic)
i_I J ��,� Lic. No. T F
lass
Contractor's Address Contractor's E-mail Address
City State F Zip F— Telephone[�
SETBACKS REAR _ SETBACKS FRONT PERMIT NO. NI Z0Z,_ — U
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $