HomeMy WebLinkAboutX2022-1312 - Permit ApplicationPant Form J Worksheet for Combo Building & Solar Permit Application c6w�gJa
r Comm" r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL o?
,Building I- Grading (—Drainage r Elec r` Mech r Plum Cu vd Cut Cu Yd Fill F
Project Address (Not mailing address) r Floodr Fire r Liq j— Landslide rN/Aj Floor Suite No
Description of Work
Use F— ConstType
# Stories #Units (if Res
SP y
Valuation $ 7 �:v
Material/Labor ZC)f
New/Add SF�— Remodel SF— Garage/New/Add
--L)ly/Uod-. _..
OWNER'S NAME Last ��-� First
Owner's Address Owner's E-mail Address 1
cityI �Zip CLS TelephoneC State
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APPLICANT'S NAME Last ������}-.�l First
Applicant's Address Applicant's E-mail Address
1
—
city State F - Zip �qq r Telephone[
ARCH ITECT/DESIGNER'S NAME Last CA N&\� Firsts � �� Lic No. C�� L1�
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Architect/Designer's Address Architect/Designer's E-mail Address
(60
City (jc _�1� State Zip �� Telephone 7
ENGINEER'S NAME(vJ Last ' First F Lic. No.F—
Engineer's Address / Engineer's E-mail Address
City State Zip �� Telephoned
CONTRACTOR'S NAME/COMPANY Lic. No. F Class
Contractor's Address Contractor's E-mail Address
City _ State �— Zip F Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO.
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SETBACKS LEFT SETBACKS RIGHT PLAN CHECK N0. _�
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $ � jq6, 57