HomeMy WebLinkAboutXC2022-2006 - Permit ApplicationPrrit Form Worksheet for Combo Building & Solar Permit Application
Comm'I ❑ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF suRMITTAI
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Building ❑ Grading E.-Drainage �FJec (12(Mech Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) ElFlood ❑ Fire ❑ Liq ❑ Landslide ❑N/A Floor Suite No
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Description of Work
Use p Ionst Type
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# Stories[ It Units (if Res)
New/Add SF�— Remodel SF Garage/New/Add
Valuation S
Material/Labor
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OWNER'S NAME LastujNli ��j/ty First
Owner's Address Owner's E-mail Address
City State Zp Telephone
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APPLICANT'S NAME Last A�,M First
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Applicant's Address - Applicant's E-mail Address
City _ � �f � State Zip ��� 7! Telephone - 2, - --_
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ARCHITECT/DESIGNER'S NAME �� — 7 J
Last er-1 First L L ILic. No. LlYh
Architect/Designers Address Architect/Designer's E-mail Address
City State r/ ZipFL�.601 Telephone C !Cry{ J
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ENGINEER'S NAME Last I First I Llc. No.��
Engineer's Address Engineers E-mail Address -
City State ' Zip Telephoned
CONTRACTOR'S NAME/COMPANY Lic. No.
(I (3� PS�FfiM1 I 6 (29bd Gass _/3 I
Contractor's Address Contractor's E-mail Address i ..
City State Zip Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO. f
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $