HomeMy WebLinkAboutXR2022-3019 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
F comm" j�Residential City of Newport Beach - Building Division o s
NOTE: PLAN CHECK FEES DUE AT TIME OF SLIRMI TAI o.
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F—Building F_ Grading r—Drainage [Elec FMech 'Plum Cu Yd CutF Cu Yd Fill F
Project Address (Not mailing address) C Flood I— F_ Liq r Landslide FN/A Floor Suite No
Fire
\ Z U v. _\-e`C._j c, coo, ` Mc. 9 26Z5_ F
Description of Work
Use s Const Type s
# Stories # Units '
New/Add SFs% — Remodel SFs—
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Valuation $
Garage/New/Add �— Material/La or
OWNER'S NAME Last x
Firsts p/tl•
Owner's Address
Owner's E-mail Addresser
-
-F-ox PeAe K p,p -
City Cs,-f_ c�>A_ m,5- r State
Zip Telephone 40S 2- 0. i t 1'
APPLICANT'S NAME Last `C _ First ► V ` \L—Q
Applicant's Address'�
Applicant's E-mail Address
City LC� -romp� State CcZ
Zip 9Z&. Telephone 7)q 3gV `tZ►`f
ARCHITECT/DESIGNER'S NAME Last First Lic. No. F_
Architect/Designer's Address
Architect/Designer's E-mail Address
City State I
Zip r— Telephone
ENGINEER'S NAME Last
First r Lic. No.F—
Engineer's Address
Engineer's E-mail Address
City F State F—®
Zip F-- Telephone[
CONTRACTOR'S NAME/COMPANY
Lic. No. �— Classs— I
Contractor's Address
Contractor's E-mail Address
City State �—
ZipF_Telephones®
SETBACKS REAR SETBACKS FRONT
PERMIT NO. X/< ZG22Z-3421 9
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $