HomeMy WebLinkAboutXR2022-3304 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
CommResidential City of Newport Beach - Building Division =
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building Grading r-Drainage r-Elec F-Mech F_PlumCuYdCut i� CuvdFiilF_
Project Address (Not mailing address) i_ Flood f- Fire F_ Liq F= Landslide f N/A Floor Suite No
Description of Work LI l bE W L,.V - ` "
Use Const Type
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# Stories #Units (if Res)
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Valuation $ n
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New/Add SF Remodel SFr— Garage/New/Add �
Material/Labor
OWNER'S NAME Last 9✓c' First,;'.,
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Owner's Address Owner's E-mail Address
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City State f--- Zip Fr'ss. ',-: Telephoner)
APPLICANT'S NAME Last F_ .. --'; First
Applicant's Address Applicant's E-mail Address
:S339 E e6A5i 5Te &3
City w".�sr TF y� State Zipf:�__.--fir Telephone r
ARCHITECT/DESIGNER'S NAME $ k, {+' 1 ' '!� `%' f�`
-. Last j '[ t ; f, ' t� First d „ t f' Lic No.
Architect/Designees Address Architect/Designer's E-mail Address
City Gy' vY.'� l .✓ State I J V Zip Telephone / _. �L� ✓ I 1 ��
Lic.No. �Z
ENGINEER'S NAME Last FirstFU
Engineer's Address Engineer's E-mail Address
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City ,�' ,,/["In.(P, 1° -" p P- State'` Zip a Telephone 1J�V7.,,.r l'
CONTRACTOR'S NAME/COMPANY i, v Lic. No. R) 41" Class E r
l f�ONFlU� C J= ContracosEyaess
Contractor's Address
DP STE j63 CAM �26
City i, State_74 Zip Telephone c� l i
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SETBACKS REAR SETBACKS FRONT PERMIT N0. _& iZ
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SETBACKS LEFT SETBACKS RIGHT CHECK NO. (,�G�J'v�
r ��, ,,�n<�lPLAN
USE ZONE DEVELOPMENT NO V� w (/+�- CfZ5 7 PLAN CHECK FEES $
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