HomeMy WebLinkAboutX2022-0968 - Permit ApplicationPrint Form Worksheet for Combo Building $ SolarnA�liq1'To
I-1 Comm" F-� esidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
I Grading r,Drainage r Elec r Mech F Plum cuydcutF7 Cu Yd Fill n
Address (Not mailing address) ❑ Flood [ Fire r Liq r La Illndslid ❑N/A Floor
Suite No
Description of Work v Use J Const Type _1
=- 72,C)�� �V� — ---
# Stories # Units (if Res) J
Valuation $
F .,
New/Add SFJ Remodel SF� Garage/New/Add Material/Labor
OWNER'S NAME
Last _ �)`� First
Owners Address
i
Owner's E-mail Address
®i
City �> �j�, � j State 1 Zip Telephonel
_
APPLICANT'S NAME
Last
I First i
Applicant's Address
Applicant's E-mail Address
City
State - I
Zip L Telephone
ARCHITECT/DESIGNER'S NAME Last�—
First
Architect/Designees Address
Architect/Designer's E-mail Address
City
State
Zip- Telephone�J
ENGINEER'S NAME
Last
First I Lic. No.F
Engineers Address
Engineer's E-mail Address
---- --- --
City I - ------------
-.. -- -- -- - - -------
State
Zip TelephoneF_
CONTRACTOR'S NAME/COMPANY -Q�r � j� �sl � i' Lic. No. & L�,�� Class
Contractor's Address
Contractors E-mail Address
City N�>
State ]
Zip �j Telephone f4rl
SETBACKS REAR
SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE
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