HomeMy WebLinkAboutXR2022-2828 - Permit ApplicationPint Form Worksheet for Combo Building & Solar Permit Application
Comm'I F,_�( Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) F7 Flood F_ Fire F_ Liq j- Landslide [_N/A Floor Suite No
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Description of Work
Use N 3 Const Type � -13
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Valuation $ '•
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New/Add SF (� Remodel
SF1 Garage/New/Add [ X(5
Material/Labor
OWNER'S NAME Last
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Owner's Address
Owner's E-mail Address
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State Lp Zip qzL�1 _ Telephone -loz 54L- ° 2't3-{
APPLICANT'S NAME Last (�w�e� First
Applicant's Address
Applicant's E-mail Address
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State L. � Zip 11ZL-53 Telephone 5`-t4.513 to So
ARCHITECT/DESIGNER'S NAME
Last j3,1; le First �—
`� Os-,;d Lic. No. GZ 1 ny
Architect/Designer's Address
Architect/Designer's E-mail Address
City Lw�0_-lly
State ik Zip 'LLc53 Telephone `t+t S13 soy
ENNAME Last
Lic No.
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Engineer's Address
Engineer's E-mail Address
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City L _ `i• i\
State �p Zip \Z�— Telephone
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CONTRACTOR'S NAME/COMPANY
Lic No. F— Class F—
Contractor's Address
Contractor's E-mail Address
City /J� _ �n _ f
State h ZIP Z 4 Z f Telephone 7
SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. /mac u1ZZ
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $