HomeMy WebLinkAboutXR2022-2381 - Permit ApplicationL Print Form J Worksheet for Combo Building & Solar Permit Application
F_ Comm'I F_ Residential City of Newport Beach - Building Division
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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[—Building rGrading (—Drainage F_Elec F_Mech F-PlumCu Yd Cut l Cu Yd Fill
Project Address (Not mailing address) C Flood F_ Fire F_ Liq F_ Landslide f N/A Floor Suite No
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Description of Work
Use � ConstTypel
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V�/�OCat �'�Y>\f1� GfPC
#Stories #Units (if Res)
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Valuation $
Material/Labor ocla 5_2
New/Add SFI Remodel SF p Garage/New/Add
OWNER'S NAME Last S First
Owners Address Owner's E-mail Address
City State �— Zip F___— Telephonel�—
APPLICANT'SNAME Last First
Applicant's Address Applicant's E-mail Address
City State I Zip �— Telephoner
ARCHITECT/DESIGNER'S NAME Last
CYI `.,JC`n First Lic. No. C'2131
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Architect/Designer's Address Architecct//Designerr''s' E-mail Address
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City %! ? State cL Zip li0`!-kJ,6� Telephone q�2
ENGINEER'S NAME Last First F Lic. No.F—
Engineer's Address Engineer's E-mail Address
City State F— Zip F Telephone[ —
CONTRACTOR'S NAME/COMPANY Lic No. F Classl
Contractor's Address Contractor's E-mail Address
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City State �— Zip � Telephone[ —
SETBACKS REAR SETBACKS FRONT PERMIT NO. O_V (T/N I
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $