HomeMy WebLinkAboutXR2022-2577 - Permit ApplicationPrint corm worksheet for Combo Building & Solar Permit Application (-.
RF Comm'I r" Residential City of Newport Beach - Building Division �n �! I
CCFS rN NOTE, PLAN HEK FFIF AT TIK= no eI [DRAI=,(i
F_ Building r- Grading r'Drainage F_ Elec r- Mech Plum F`
Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) F_ Flood
r- Fire F_ Liq r- Landslide f N/A Floor Suite No
Z 6?s A M t_4 I TVs
s- F--_
Description of Work
Use s Const Type s—
�Y.-ize u)ig-
# Stories # Units (if Resf
Valuation $
Material/Labor
New/Add SFs-- Remodel SFF-
Garage/New/Add F—
OWNER'S NAME Last o {{ Li A_�, Fr
First `C
Owner's Address
E S A /-tz +11
Owner's E-mail A ress J/
City / Zi N /�
�— P I Tele Phone3 /o "e CY '- /Q
^^State
APPLICANT'S NAME Last S///ii vet a
FirstS
Applicant's Address
Applicant's E-mail Address
xt Vie- �� .60
City 12 State F
Zip I y Telephonel
TT
ARCHITECT/DESIGNER'S NAME
Last ��%� ik First F7I ^T Lic. No. �—
Architect/Designer's Address
ArchitecUDesigner's E-mail Address
U,07 �h�r l � Lc? ,� v ��
City State �—
j
Zip— Tele hone
P s =Sod Yid` e_
ENGINEER'S NAME Last �61'j�c
First �7,4� Lic. No.
Engineer's Address
Engineer's E-mail Address
G�RL_< �/ Z
L
City A4l/7� State
Zip TelephoneFT;,
J v'
CONTRACTOR'S NAME/COMPANY Lic. No. JG Class
J
Contractor's Address
Contractor's E-mail Address
d C
Ci , fj State C'
ty
Zip�G Telephone 7l S�l/,
O `t 7
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $