HomeMy WebLinkAboutX2022-0193 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application l lli
(- Comm'] r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
_-Building _Grading _Drainage I-Elec F-Mech
_Plum Cu Yd cut Cu Yd Filll
Project Address (Not mailing address) F7 Flood
I- Fire (- Liq I- Landslide I _N/A Floor Suite Ni
Description of Work
Use F Const Type F
L2 tj
Storesl�#Units (if Res)r
Valuation $
Material/Labor F9
New/Add SF F— Remodel SF IF Garage/New/Add
OWNER'S NAME Last WPC) First 1
Owner's Address �" F 0 (7\
Owner's E-mail Address
10 �pj XPi L� SI
City �� State C/Fc
Zip `,� b�3 TalephoneE4�1�S
APPLICANTS NAME Last 15 M 1�
First
Applicants Address
Cfa(
Applicant's E-mail Address
A',v�ussmt-r14 4Gbw
City S�� ' Aw � _ _ State •/\
T
Zip 9 7 a��-- T—eleph—one `�j—(t��
ARCHITECT/DESIGNER'S NAME Last'l
First Lic. No. �—
ArchitectlDesigner's Address
Architect(Designer's E-mail Address
.. .. - _. ._._ __ ..._
City State �—
— --
Zip ! Telephone
ENGINEER'S NAME Last i x I R V
First I Q I(A Iv CLic. No.r
Engineer's Address
I o (��VZOOQ-14O�1 OW ES
Engineer's E-mail Address
d
City �(} �t✓{% State
Zip 1�`J ().S Telephone['. 14 6 �,� S I D
CONTRACTOR'S374 (( b Class Z
NAMEICOMPANY CC Lic. No.
N Cyt�S Jf/1 I. 4'-F L/ O "S6
Contractor's Address-
1 �� 4 CI�Nwotu �� lC ---
Contractor's E-mail Address
���ssPA iTI4 GUx . N
City ( (�_ GN Qa State G
Zip �% Q Telephone, 14
SETBACKS REAR SETBACKS FRONT PERMIT NO. X W72. otgy
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. 105.202-2
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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