HomeMy WebLinkAboutX2022-1091 - Permit ApplicationPCint Forme. Worksheet for Combo Building & Solar Permit Application
F-, Comm'I rrResidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF, SUBMITTAL
f;X6Building ❑'Grading ❑Drainage ❑Flee ❑Meth
❑Plum cu Yd cuc�) Cu Yd Fill17
Project Address (Not mailing address) ❑ Flood r. Fire ❑ Liq ❑ Landslide ❑N/A Floor Suite No
VlA �`. S01(n ieC,r'�`�'
Description of Work
Use ConstType�
# Stories # Units (if Res)C
e-S
Valuation $
Material/Labor[ TS
-
New/Add SF C� Remodel SF Garage/New/Add F C
OWNER'S NAME LastFirst
Owner's Address
Owner's E-mail Address
City State—',
Zip 17_77 Telephoned
APPLICANT'S NAME Last (
First
Applicant's Address
Applicant's E-mail Address
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City -- ' State
Zip Telephone ZIP-'✓i s yVL��
ARCHITECT/DESIGNER'S NAME Last
First �—
Lic. No.
Architect/Designer's Address
i
i
Architect/Designer's E-mail Address
i
City - State
Zip �, Telephoned
ENGINEER'S NAME Last 71P___ ( First (j` j1 Lic. No.
Engineer's Address
Engineer's E-mail Address
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[IC -,Y�ee;n � x.
`jC s�ti-� �'vV-
City `L y�l State
Zip Cj �/y Telephone p.
CONTRACTOR'S NAME/COMPANY.
Lic. No. F Class F7
Contractor's Address
— — -
Contractor's E-mail Address
City - tate
— Telephone —
Zip F77d
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. I - =✓22
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $