HomeMy WebLinkAboutXC2022-2041 - Permit ApplicationF=rint Form J
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Worksheet for Combo Buiid'Irug & Solar Permit Application
Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
wilding F- Grading j—Drainage �N/tiec ech lum CuYdCut - CuvdFill
Project Address (Not mailing address) F_ Flood j- Fire F- Liq F- Landslide F_N/A Floor Suite No
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Description of Work
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# Stories #Units (if Res)-
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New/Add SF Remodel SF ' S� Garage/New/Aw/A dd
Valuation $
Material/Labor Ft Z., GtYG
OWNER'S NAME Last ��� First GFlI,AA.6
Owner's Address Owner's E-mail Address
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City �Q11i1A/ti State fit, Zip FJ1 7,6t2 Telephone
APPLICANT'S NAME Last S 2 eQ First' J S!3,, GA
Applicant's Address Applicant's E-mail Address S 2 kJ5(�C) fr!}1vt lw L
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City tate Z0l0�Teleph�aneFj��3�_
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ARCHITECT/DESIGNER'S NAME Last V WLFirstFsysAA Lic. No. G, 33 24
Architect/Designer's Address Architect/Designer's E-mail Address
City /�U ciLT 3L 4G State I 1— Zip t��7 Telephone �1+6i _ �o�� _ 2�.�
ENGINEER'S NAME Last First Lic. No.
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Engineer's Address V40 Engineer's E-mail Address "A/ArrTp piT
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City( \LVIAti� State CA Zipi 926(e Telephone �j40�_ 7
Lic. 1 ��Class
CONTRACTOR'S NAME/COMPANY ;1�,o
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Contractor's Address ( r r s E-mail Address
city I State Zip Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO. 2c Ll 1
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $