HomeMy WebLinkAboutX2022-0234 - Permit ApplicationPrig Form Worksheet for Combo Building & Solar Permit Application
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F Comm'I Residential City of Newport Beach - Building Division V 1
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL V "V'il I, �tA
Building r" Grading j—Drainage r Elec
j-Mech r Plum cuvdcut
F- CuvdFill
Project Address (Not mailing address) f Flood r Fire r Liq Lan!!lldslideN/A Floor
�5gy r
of Work
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Suite No
iseConst Type F_
Stories? # Units (if Res)[
New/Add SFF - Remodel SFF �:::�Garage/New/Add Valuation $/�
Material/Labor U� �lJo
OWNER'S NAME Last
r G� I First OUq ----
Owner's Address -
Owner's E-mail Address
City State
FOV Zip
- K/ Tele hone! ,_
First 1)Q5e1 j 1
APPLICANTS NAME Last � �1�/�
� _ _
Applicant's Address - --_-- - ---- _
Applicant's E-mail Address
Awl I
City State /U \
Zip Z. -.. T lephone
ARCHITECT/DESIGNER'S NAME b Lv /U
Last M(7iV1��9� ,First r
Architect/Designees Address 1G1 Lic. No.
Architect/Designer's E-mail Address
city L( vc,�G,c _ _ state (/�//
I (� Zip - I� L% Cj Telephone(7M
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ENGINEER'S NAME ME Last
Engineer's Address f�Ur-- n 777
First ��'��fY�(�-y - Lic. No. ��CJ
Engineer's E-mail Address
City Zi
U 13 CI�1 State '�/� �56�
-- N - p 1 Telephone
CONTRACTOR'S NAME/COMPANY \ r IV 1
r,es(�n Lic. No. F� ✓1 Class
Contractor's Address
Contractor's E-mail Address
City State(�
Zip �� Tele hone
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT PERMIT NO. _X7422 —Q� 3
USE ZONE PLAN CHECK NO.
DEVELOPMENT NO .�2(. (I' -y q PLAN CHECK FEES $ eV Z Z
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