HomeMy WebLinkAboutX2022-1623 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
r Comm]Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL a"
F_ Building F_ Grading F-Drainage XElec F Mech
%Plum CuYdCut CUYdRI F
Project Address (Not mailing address) F_ Flood
r Fire (— Liq F_ Landslide F_N/A Floor Suite No
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Description of Work
Use s Const Type s
# Stories # Units (if Res)[ —
Valuation $
Material/Labor 501000
New/Add SFF RemodelSFF_ Garage/New/Add
OWNER'S NAME Last
First -I-o J
Owner's Address
Owner's E-mail Address
City K ( TCo(,:�> State I C:�-k
Zip I Z(e57 Telephone 4�313q_(o
APPLICANT'S NAME Last
First -MtW,3
Applicant's Address
Applicant's E-mail Address
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City jQr - r?e-r- 5T State
Zip �{ Telephone (�'�3 q
1
ARCHITECT/DESIGNNEIR'S NAME Last First F
Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City State F
Zip r Telephones
ENGINEER'S NAME Last
First 7— Lic. No.s—
Engineer's Address
Engineer's E-mail Address
City State F__
Zip F_ Telephoned
CONTRACTOR'S NAME/COMPANY
Lic. No. F Class s
Contractor's Address
Contractor's E-mail Address
City I State F—
Zip Telephoner —
?'012 � ' 6 2?
SETBACKS REAR SETBACKS FRONT
PERMIT NO. /<
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. I4 7 g' 7.07,2
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $