HomeMy WebLinkAboutXR2022-2776 - Permit ApplicationPrint Form Worksheet for Combo Building &Solar Permit Application 91--1,City of Newport Beach -Building Division X��Z T, jComm'I 7 Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
j Building (- Grading
F-Drainage F_ Elec F" Mech
r Plum Cu vd cut Cu Yd Fill
Project Address (Not mailing address) F= Flood
F_ Fire F_ Liq F- Landslide FN/A Floor Suite No
Description of Work
Use F ConstType
_
# StoriesF_ # Units (if Res)F
Q
Valuation $
Material/Labor
New/Add SFF— Remodel SFF— Garage/New/AddF— —
OWNER'S NAME
Last
First
Owner's Address
Owner's E-mail Address
City
State F_
Zip F_ TelephoneF—
APPLICANT'S NAME
Last
First
Applicant's Address
Applicant's E-mail Address
City
State
Zip r Telephone
ARCHITECT/DESIGNER'S NAME Last -
Lic. No.
First F
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State F
Zip Telephonef -'--
ENGINEER'S NAME
Last
First �— Lic No.F
Address
Engineer's E-mail Address
rEngineer's
•�'
City
State F—
Zip Telephoned
CONTRACTOR'S NAME/COMPANY �{ I 1 �., `� .�
Lic No. I �MI 51) (1 Class�
V t
Contractor's Address
Contractor's E-mail Address
licl
Cot
C' �1111�G�'�reCI
City f�'�.�.��,ll� l �?��l�V State 1
+.CCCM �
Zip G1��. ,��6 Telephone ��o -(] oI_)
Cl Io
SETBACKS REAR
SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.
r
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $