HomeMy WebLinkAboutX2022-0298 - Permit Application (2)Print Form W
eet for Combo Building & Solar Permit Application
Comm'I ❑ Residenti
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-l� City of Newport Beach - Building Division(
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBIMITTAL
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( Building El Grading
❑Drainage �flec [Tech Plum Cu vd Cut I
Cu Yd Fill
Project Address (Not mailing address) ❑ Flood ❑ Fire ❑ Liq [) Land--slidide ❑N/A Floor �I
Suite No
Description of Work
_ I e_ 1
# Stodes jj i # Units (if Res)o
New/Add SF � Remodel SF Valuation; !
Garage/New/Add Material/Labor
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OWNER'S NAME Last _ '( �'"�' I !
First
Owner's Address
Owner's E-mail Address
City ���� ! State Zip 1 7 Y.b 1 1 1 Telephone q U-0f)
APPLICANT'SNAME Last I \Off ! First ---
Applicant's Address - - Applicant's E-mail Address
Ccity Q L( I State Zip q Z J7! Telephonery
ARCHITECT/DESIGNER'S NAME Last
da, ,�,b First PA4L ! Uc.No_ �
Architect/Designer's Address ---�(
ArchitectlDesigners E-ma0 Address
G�� i
City ) yl% (/� ���/� State C'�! " ZIP 2jj6J Telephone, _ Cbb C
ENGINEER'S NAME
Las[ First i Lic No.17
Engineer's Address Engineer's E-mail Address
City State I Zip �! Telephoned j
CONTRACTOR'S NAME/COMPANY �Q �� P�)I —I Lic No. Class
Contractor's Address 'C—ontractor's E-mail Address
City State
.__. Zip j Telephone j `
SETBACKS REAR SETBACKS FRONT PERMIT NO. Lt J 1
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. +
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $