HomeMy WebLinkAboutX2022-1020 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
j Comm'I r�Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
nBuilding jGrading Drainage ❑Elec f-,Mech Plum Cu Yd cut Cu Yd Filll
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Project Address (Not mailing address) ❑ Flood F_j Fire rl Liq n Landslide ❑N/A Floor Suite No
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Description of Work
Use L ' Const Type �l
#S - F# Units (if Re s)n
L -we, fit'-Fuu�� IP>RU
New/Add SFF ____ -i Remodel SFF_� Garage/New/Add F __J
Valuation
Material/Laa bor
OWNER'S NAME LastFirst
Owner's Address Owner's E-mail Address
City , ----.......---------� State - A-.-] Zip 4`�- . �cd Telephone .1-_) 0_�--s
APPLICANT'S NAME Last First j
Applicant's Address ®®— Applicant's E-mail Address
City State FI Zip F j Telephoned
ARCHITECT/DESIGNER'S NAME Last First F77777777 Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State Zip � Telephoned
ENGINEER'S NAME Last First �I Lic. No.
Engineer's Address Engineer's E-mail Address
i
City State �, Zip Telephoned
CONTRACTOR'S NAME/COMPANY � ��Gl �0�� We (C D� Lic. No. t�t�7 -6 Class
Contractor's Address Contractor's E-mail Address
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City t�-- -- - - State ZipTelephoneG%-_� I ��
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
PERMIT NO. X-Le)?iZ I D
PLAN CHECK NO. 0 C o - 7QYZZ
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $