HomeMy WebLinkAboutXR2022-2645 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division
r Comm'I Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
j Building F_ Grading j-Drainage F- Elec r Mech r Plum CuvdC4_ CuvdFnl
Project Address (Not mailing address) F- Flood r Fire r Liq r Landslide F_N/A Floor
425
of Work
0
Suite No
Use F_ ConstType
A" V w PL-%< t# StoriesF_ A Units (if Res)F—
A 0 0 , Ti o i.-1
Valuation Fc)
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New/Add SF 1$ O Remodel SF F— Garage/New/Add �— Material/Labor
OWNER'S NAME Last I µAR`�cd, ?o �T (q First I L pr.wC
Owner's Address Owner's E-mail Address
423 loZN� ST Lwk5, Et.F4T��G.C�r+-
City g;WPo T �jfzP.c-ra State � Zip �l2lv/oy� Telephone'(l•(-74j-j?%S
APPLICANT'S NAME Last I G's7�/�� First
Applicant's Address Applicant's E-mail Address
City State [_ Zip F_ Telephoned
ARCHITECT/DESIGNER'S NAME Last i :y, ^ et- /J First p. rv. (T p. p Lic. No.
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Architect/Designees Address Architect/Designer's E-mail Address
2�}31 o ntOrrt^TO/J PKwi r7V1'f'�'i CJ ' laGi
City GAt�NA �Fi��3 State �— Zip 92103? Telephone 9.fq _ �/o -/¢/7
ENGINEER'S NAME Last
Engineer's Address
State �— Zip �_ Telephoned--
Lic. No. F_
ClassF
City
First I Lic.
CONTRACTOR'S NAME/COMPANY
Contractor's Address
Engineer's E-mail Address
Contractor's E-mail Address
(0
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City Sta e F Zip F— Telephone[ —
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. ZV7
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $