HomeMy WebLinkAboutX2022-1292 - Permit ApplicationPnrit Form Worksheet for Combo Building & Solar Permit Application
[Residential City of Newport Beach - Building Division
j- Comm'I NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building [ Grading Drainage F Elec - Mech P.lum Cu Yd CutFCu Yd Fill
Project Address (Not mailing address) F�- Flood r Fire r- Liq r Landslide [N/A Floor Suite No
Description of Work
seConstType�j
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0i j hU �\1 .
tories# Units (if Res)
Valuation $
Material/Labor -279 �7M
New/AddSFF RemodelSFF Garage/New/AddF-
OWNER'SNAME Last— First M1 pC1�
Owners Address _ - Owner's E-mail AddreJss
City _ State �— Zip Telephone--
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
- -----
Pity „_ State Zip Telephone
ARCHITECT/DESIGNER'S NAME
- Last -- ;First F_: Lic. No. �—
------ -- --
Architect/Designer's Address ArchitecUDesigner's E-mail Address
,City .. State �- Zip F— Telephoned
ENGINEER'S NAME Last First Lic. No.
Engineer's Address - Engineer's E-mail Address
- - —---------- -------------
.City State Zip Telephone
CONTRACTOR'S NAME/COMPANY Lic. No. Class
Contractor's Address Contractor's E-mail Address
City 1'����m - State Zip C Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO. INLGZ2-
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. 1' 9
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $