HomeMy WebLinkAboutX2022-0829 - Permit Application�rtttFarrrtWorksheet for Combo Building & Solar Permit Application
I -Building Division C'I
,?Zv&ity of Newport Beach r> —1
Commll DZResldential 07 1�y NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL oil
F Plum
. Plum
f-13uilding f— Grading Krainage f—, Elec f7, Mech C Yd C477 Cu Yd Fill F7
Project Address (Not mailing address). Flood F7 Fire F_i, Liq f—, Landslide J,_ N/A Floor Suite No
of Work
Use ConstType F7
# StoriesF # Units (if Re47
-- ----ageI Valuation $
Gar'/New/Add Material/Labor
New/Add SFF7777 Remodel SFF77777 F777 Fq D
OWNER'S NAME Last
Owner's Address
City
APPLICANT'S NAME Last
First
Owner's E-mail Address
WT
r7_T_
State IQ C( zip
Applicant's Address
City F� State
ARCHITECT/DESIGNER'S NAME Last
Architect/Designer's Address
City
ENGINEER'S NAME Last
Address
Zip
First
Applicants E-mail Address
FirstF777777
E-mail Address
Lic. NoT7777
Telephone
City State zip
Lic. N Class
y r:T-\,-. 0. F? _(93771 r;
CONTRACTOR'S NAME/COMPANY 00 11, 41
COCOO
Contractor's E-mail Address
ffontractor's Address
t e Zip Telephone -- 7--
-
City
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
LN
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $