HomeMy WebLinkAboutX2022-0461 - Permit ApplicationPrint Form
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Worksheet for Combo Building & Solar Permit Application
Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building C'Grading [Drainage , ElecMech
)i Plum Cuvd Cut Cuvd Fin
Project Address (Not mailing addre F-' Flood [ Fire F- Liq r Landslide EWA Floor Suite No
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Description of Work
Use ' ConstType
#Stori s %Units (ifResC
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Valuation a S
Material/Labor (
New/Add SFF— Remodel F Q Garage/New/Add
OWNER'S NAME Last
First -
Owner's Address
Owner's E-mail Address
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City rat Y_ jrkr State
Zip �� Telephone513
APPLICANT'S NAME Last ?
First
Applicant's Address
Applicant's E-mail Address
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1 AA ') _
City �f 1�t�L,A State ' _
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Zip 1 rYTel��e yf - 1I )v� '` (. �?
ARCHITECT/DESIGNER'S NAME Last First c .
�— I_-(z Lic. No.
ArchitecNDesigners Address
Architect/Designees E-mail Address
31a
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City � t j��1�� State
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Zip .in
Telephone ;i �-. 3 ) )
ENGINEER'S NAME Last
First _ Lic. No.
Engineer's Address i
Engineers E-mail Address
) I�Z 1) .11,E _ 1%
City - - ---- State I
Zip 7 Telephone +'1-�� 3-i (G'5o
CONTRACTOR'S NAME/COMPANY
No. Class -
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Contractors Address
Contractors E-mail Address l'
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Grcto d�aana�iur�ry co
City L_aC AV4_-State
Zip 1 Telephone
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. L ( L
USE ZONE DEVELOPMENT NO )
' e PLAN CHECK FEES $