HomeMy WebLinkAboutXR2022-2379 - Permit ApplicationLPrintForm J Worksheet for Combo Building & Solar Permit Application (14m,
Tint For
7 Comm'I 7 Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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F-Building r Grading F-Drainage r-Elec FMech F- Plum cuYdCut F_ cuYdFill F_
Project Address (Not mailing address) F Flood F Fire r- Liq F_ Landslide F_N/A Floor Suite No
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Description of Work
Use I r` Const Type
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# Stories # Units (if Res)F
Valuation $ �O
Material/Labor �O �
New/Add SF Remodel SF y Garage/New/Add
OWNER'S NAME Last l�(Jv 1 t(il� First
Owner's Address Owner's E-mail Address
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City M, _tw 6c" State F5� Zip F,_ TelephoneF__—
APPLICANT'S NAME Last 3 S ; SvI First <
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Applicant's Address Applicant's E-mail Address
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City - State �` Zip �/2 Telephonefol.l}LZ�QS�
ARCHITECT/DESIGNER'S NAME Last I(1 r First �—
�� S Lic. No. �2"(31
Architect/Designer's Address Architect/Designer's E-mail Address
City State �— Zip �2 � Telephone �, Ot , 12 .�C1
ENGINEER'S NAME Last F First F Lic. No.7—
Engineers Address Engineer's E-mail Address
City State F— Zip �— Telephoned --
CONTRACTOR'S NAME/COMPANY -r n(� i Lic. No. Fi 1'3 S Z Class
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Contractor's Address Contractor's E-mail Address
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City 5 State C� Zip qZ,l Telephone �r.tc(®t
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK N0.(J`L2
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $