HomeMy WebLinkAboutX2022-0496 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application �_R °
F_ Comm'I F- Residential City of Newport Beach - Building Division X 2022- 04 Ci CO o d
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL ,11� •l
rBuilding r Grading F -Drainage r Elec r Mech r—Plum Cu Yd cut Cu Yd Fill F
Project Address (Not mailing address) F_ Flood F_ Fire F_ Liq F- Landslide F_N/A Floor Suite No
Description of Work
Use 'Const Type
121
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# StoriesF # Units (if Res)
- -
Valuation I� OOQ
Material/Cabo
New/Add SFF— Remodel SF Garag F_ a/New/Add
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OWNER'S NAME Last� /AN j � First
Owner's Address Owner's E-mail Address
City ( State— Zip Telephone -
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
City State ... Zip r. Telephoned _.... __
ARCHITECT/DESIGNER'S NAME Last l Jb DJQ6 First r, Lic. No.
Architect/Designer's Address Architect/Designner'ss�E-mail Address
es�s /�j� ��j--
City NS� 1 State MA7 Zip 5 Telephone
F 1Last
ENGINEER'S NAME First —', Lic No.F—
Engineer's Address Engineer's E-mail Address
City State —, Zip F_ Telephone
n Lic. No. 6T 35 2', Class
CONTRACTOR'S NAME/COMPANY - j v v 4� ,{ / ® sI u� Of
JYContractor's
Contractor's Address E-mail Address
city State F_ Zip F— Telephoned
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. t-%
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $