HomeMy WebLinkAboutXR2022-3053 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
r Comm'I r Residential City of Newport Beach - Building Division
NOTE PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
�1 v
(QBuilding 1 Grading 'Drainage �Elec jMech Plum CurdCut FT CuvdFill
Project Address (Not mailing address) Flood F- Fire r Liq r Landslide FN/A Floor Suite No
Description of Work Use R3/U Const Type VB
New 5VK VVIATE Glara i is KM pa # Stories # Units (if Res)s
Valuation $ ` ./�
New/Add SF ) model Garage/New/Add Material/Labor
OWNER'S NAME Last G` / First
Owner's Address Owner's E-mail Address
City QV State �/ Zipilf C lr
TelephoneF—
APPLICANT'S NAME t { /y�qo
Last ��,� First
�/ tel
Applicant's Address Applicant's E-mail Address 4 v
D 1-1nV__ Yt�r��
-n -
city (_-----�J� D/ y1 / State Zip (W Telephone 51 I6
ARCHITECT/DESIGNER'S NAME Last � 6 (s1 - First Lic. No. C23971
Architect/Designer's Address Architect/Designer's E-mail Address
ZD_31 -T l — 1 - 110 -
City iWrOOState CA Zip ' t //tC�t(' � Telephond'/L/{.f - C{ r/vf,_ q 2W
ENGINEER'S NAME Last l First Lic. No
Engineer's Address Engineer's E-mail Address
City I l V I State I—/t� Zip Telephone- _ 1
V� - - -
CONTRACTOR'S NAME/COMPANY j Lic. No. I Classy
Contractor's Address Contractor's E-mail Address
26880 Aliso Viejo Parkway, Suite 100
City 1, %/�/� State Zip Telephonel—
SETBACKS REAR " o SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. ��JZZ Z
USE ZONE DEVELOPMENT NO I PLAN CHECK FEES $
I