HomeMy WebLinkAboutX2022-1529 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application
r Comm'] Pre Residential City of Newport Beach - Building Division (
NOTE: PLAN CHECK FEES DUE AT TI
ME OF SUBMITTAL -
Building r Grading rDrainage lec ech j��
�Um cu vd Cut l Cu vd Fill
Project Address (Not mailing address) r Flood r Fire r Liq r Landslide (—N/A Floor Suite No
Description of Work
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Use � ponst Type u Q N�
# Stories �V # Units (if Res)
New/Add SF Remodel SFt'
valuation $1441 Garage/New/Add Material/Labor
a or (� `
OWNER'S NAME Last
64— �"y wn
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Owner's Address
Owner's E-mail Address
City
State �—
Zip �— Telephone .1SG
APPLICANT'S NAME Last
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First
Applicant's Address
SIO c,AWcS Fort
60
Applicant's E-mail Address
City State �j
WA•G2. 1 � 6�IVl�I'I L . Can
ZIP �� Telephone C
(( 77 vv
ARCHITECT/DESIGNER'S NAME
Architect/Designer's
Last A^�f,/w .►
First F� A
Lic No. S
Address
Architect/Designer's E-mail Address
City I
State F
Zip [_ Telephone[—
ENGINEER'S NAME Last
First I Lic No. ?5736
Engineer's Address
Engineer's E-mail Address
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City
State F_
y.fA
Zip F-- Telephone
q4q 9 SOa
CONTRACTOR'S NAME/COMPANY
I
* yNo.
�— Class�—
Contractor's Address
Contractor's E-mai Address /
City
State �—
Zip I Telephone
SETBACKS REAR
SETBACKS FRONT
PERMIT NO. /<ZL
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO. ! s t
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $