HomeMy WebLinkAboutX2022-0003 - Permit Application,IlPrirlt, Worksheet for Combo Building & Solar Permit Alonlication
Comm,l 9<Residential City of Newport Beach - Building Division 612-0605
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMI L
f&Building F_ Grading F -,Drainage F-, Elec r - Mech - Plum Cu Yd Cut F_ Curd Fill
F
Project Address (Not mailing address) F Flood F- Fire
F_ Liq F_ Landslide
F_N/A Floor
Suite No
_7
New/Add SFF- Remodel SFr-; - Garage/New/AddF__
OWNER'S NAME Last I 1743--1,.9VL-
Owner's Address
City'
State
First I /?- eae
Use F7 Const Type 1_77
StoriesF__ # Units (if
Owners E-mail Address
A -/?
Zip F�Z�ZS - Telephone l7/v-
APPLICANT'S NAME Last Firstl
Applicant's Address
-7
City State df
Applicant's E-mail Address
zip[- Telephone[5;��_41R5�9;�,K..
ARCHITECT/DESIGNER'S NAME Last First Lic. No.F_
Architect/Designer's Address
City F State F
Architect/Designees E-mail Address
Zip F_ Telephone[ ----- -
ENGINEER'S NAME Last First F Lic. No.F-
Engineers Address
City F_ State F
Engineers E-mail Address
Zip TelephoneF
CONTRACTOR'S NAMEXOMPANY LClass / F,�F
...Lic. No. . ..... .. . .. '".
Contractors Address
7` -
city yam -,,,7 ,g- State
Contractor's E-mail Address -
Zip_T773. Telephone
F:P;?
�7
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USEZONE DEVELOPMENT NO PLAN CHECK FEES$