HomeMy WebLinkAboutX2022-0683 - Permit ApplicationPrint Form
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Worksheet for Combo Building & Solar Permit Application
Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FFFR ni IF AT TmeF nF ci ianniTTAi
(`Building r Grading
j;Drainage r Elec r Mech r Plum CuydCut CuYdFill
Project Address (Not mailing address) r Flood r Fire I— Liq f— Landslide FN/A Floor Suite No
Description of Work
Use Const Type
77 5
# Stories •` #Units (if Res)
New/Add SF 13
Valuation $
Remodel SF /� ?) Q Garage/New/Add—, Material/Labor '
OWNER'S NAME
Lasti. y,y'rt�11nG�_
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First �riC�YtW
Owner's Address
Owner's E-mail Address`
City
State I—
Zip Telephonef
APPLICANT'S NAME
Last-one$U�
First grWS
Applicant's Address
Applicant's E-mail Address
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City J t ✓ (1Q
State C �--..
Zip � l f �' Telephone jq 5 s j -eb2(, _-
Last cc.(
First F--e r11�; Lic. No. F_
tecUDesigner's Address
Architect/Designer's E-mail Address
Cftlue
City
State F
Zip �— Telephone—
NGINEER'S NA
Last
-- __--. _
First F Lic No.F_
Engineer's Address
Engineers E-mail Address 4
City ._ - .
- -..-. State F
Zip Telephone— - - - --
CONTRACTOR'S NAME/COMPANY Fl,'f 1 P
LicNo. ff �-f 7 Class 6-
Contractor's Address
Contractor's E-mail Address
City
State F_
Zip � Telephone —
SETBACKS REAR i
SETBACKS FRONT
j I PERMIT NO, O(v03
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO. 6Lb — 2U2 ;-
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $