HomeMy WebLinkAboutX2022-0041 - Permit ApplicationX 2 02- Z a G 2 e wP 4- Cd as
Print Form Worksheet for Combo Building & Solar Permit Application (Pal
�Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL .
f-Buildingr- Grading rDrainage r-Elec r -: Meth r Plum Cu rd cut F Cu Yd Fill F
Project Address (Not mailing address) FFlood r- Fire r-; Liq r- Landslide FN/A Floor Suite No
Description of Work
Use F, Const Type F_
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#Stories #Units (if Res) '
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Valuation $
New/Add SFF- Remodel SFF— Garage/New/Add F_/
Material/Labor r�`
OWNER'S NAME Lastf
� ,�,Alc`ldZl First
Owner's Address r r"_C' C e /2'',-_TaGii / Owner's E-mail Address
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City ,Zr vi,,a ._... ''. State e/� - Zip G l.G�e ! `% Telephone j 7 1 " 7,00 3 '7
APPLICANT'S NAME Last I r. �� First F,0, GyN *
Applicant's Address Applicant's E-mail Address
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City L✓� ry. o.0 !._. State Zip I -//);? TelephoneFzi.2
ARCHITECT/DESIGNER'S NAME Last 49 First F Lic. NoF —,
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Architect/Designer's Address Architect(Designees E-mail Address
City I State F—. Zip F— Telephoned—
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ENGINEER'S NAME Last �— First F_ Lic. No.�-
Engineer's Address Engineer's E-mail Address
city F_ State �— ZIP �— Telephone
CONTRACTOR'S NAME/COMPANY /D Lic. No.�d f�j�f4 4 7 Class
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Contractor's Contractor's E-mail Address
iAddress
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City N�rt6 �,.... State � ZiP (Ze: S 2. Telephone !J 6.3'. J'7,3! 3.
SETBACKS REAR SETBACKS FRONT PERMIT N0. W m • 00�
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. 60 3 -t*22
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $