HomeMy WebLinkAboutX2022-1230 - Permit ApplicationPrint Form
F_ Comm'I
Worksheet for Combo Building & Solar Permit Application
Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME nF CI IRMITTAI
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15fBuilding F_ Grading F—Drainage PC,Elec j`Mech r Plum cuvdCut [_ cuvdFill F_
Project (Not mailing address) F_ Flood F_ Fire F_ Liq `_ Landslide N/A Floor Suite No
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Description of Work
Use F Const Type
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# StoriesT # Units (if Res)[—
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New/Add SF�— Remodel SF v
Garage/N /Add 72_;;;
Valuation $
Material/LaboFE;�100()
OWNER'S NAME Last i
First '1
Owner's Address
Owner's E-mail Address
City tJ. r - e ,) State I - ,
Zip ''j_�`3 Telephoned' � '1�.1001
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APPLICANT'S NAME Last Z i JV I i „� r -i
�.�vl�Jb
VJ;( I 1,6(
6( W)
Applicant's Address
Applicant's E-mail Address
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City A ti,, y f State
Zip �j� Telepho?Il
ARCHITE E IGNO'S NAME
First (ti�l Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City F State F—
Zip �- Telephone[�
ENGINEER'S NAME Last `-'lJ"� V bra IFI
� Y✓1
First ; „i„ �y I Lic. No. 5 v�1 to
1
Engineer's Address
Engineer's E-rraillAdddrresss
City State -_
Zip jZG2�] Telephone �q�C1 6
/
CONTRACTOR'S NAME/COMPANY
Lic No. F— ClassF_
Contractor's Address
Contractor's E-mail Address
City State �—
Zip �— Telephone,�l�
SETB KS REAR SETBACKS FRONT
PERMIT NO.
BAC S LEFT SETBACKS RIGHT
PLAN CHECK No.
RSE
US 0 DEVELOPMENT NO
PLAN CHECK FEES $
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