HomeMy WebLinkAboutXR2022-2402 - Permit ApplicationL Prmt F°rm___j Worksheet for Combo Building & Solar Permit Application
F Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F-Building F_ Grading r-Drainage j- Elec F Mech F" Plum Cu Yd cuts
CuY i
Project Address (Not mailing address) C Flood (— Fire f— Lin r— Landslide M A loor
Suite No
Description of Work
Use F— ConstType F_
# Stories # Units (if Res)s
New/Add SFs— Remodel SFs-- Valuation $
Garage/New/Add F Material/Labor
OWNER'S NAME Last 1 E'er
1` fie` First 7_177 ,
Owner's Address
I- Owner's E-mail Address
y
-itC- I State V �, Zip G ._ Telephoner
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City
- -
State F— Zip � Telephone�—
ARCHITECT/DESIGNER'S NAME Last
First �— Lic. No. �
Architect/Designer's Address ArchitecUDesigner's E-mail Address
City
State �— Zip[— TelephoneF—
ENGINEER'S NAME Last
First F� Lic. No.F—
Engineer's Address Engineer's E-mail Address
City
State �® Zip �— TelephoneF�
CONTRACTOR'S NAMEXOMPANY q l' ( , I Lic. No. 55
Contractor's Address9 Con cto s E-mail Address
Cit
yr
I - � �l t L I Zip Z 1 Telephone
KS REAR SETBACKS FRONT /PERMIT NO.
X� WZ2- 2 No 2
KS LEFT SETBACKS RIGHT PLAN CHECK NO.NE
DEVELOPMENT NO PLAN CHECK FEES $ 2ZY�p