HomeMy WebLinkAboutX2022-0340 - Permit ApplicationPrint Form 1 Worksheet for Combo Building & Solar Perm to pplication
F comm" r Residential g o9`d'�Rm
City of Newport Beach - Building Division /�'m -
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding r Grading rDrainage lec r',Mech r Plum CuvdCut 177 Cu Yd Fill I
Project Address (Not mailing address) r, Flood r; Fire r Liq r Landslide rN/A Floor Suite No
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Description of Wo Cl-f�e�L(Sc �"r<��%]r 17�C�1 CESSiyP
Use Const T e �
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Cq% (C6!"Pr% CV
# Stories # Units (if Res)
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New/Add SF Remodel SF� Garage/New/Add
Valuation 5
Material/Labor
OWNER'S NAME Last First v y
Owner's Address Owner's E-mail Address
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City w_C-0- ect&__..j State _.._.. ZiP DTelephone G
APPLICANT'S NAME Last
Applice its Address Applicant's E -mai Address
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City ---S -1--rt_Q C State zip Telephone
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ARCHITECT/DESIGNER'S NAME
First Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City _-_-_- _.I�� State ��i, Zip Telephone��
ENGINEER'S NAME Last First F Lic. No.
Engineer's Address Engineer's E-mail Address
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City �— State F_ Zip I, TelephoneF
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CONTRACTOR'S NAME/COMPANY n A ��s� d fC Lic No. � ��2 Class l
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Contractor's Address Contrajctor's E-mail Address C ✓(
City VV"tx �c /yl�,< State �— Zip Telephone- 75 W
SETBACKS REAR SETBACKS FRONT PERMIT NO. WZ%i • n'.�TI
SETBACKS LEFT D SETBACKS RIGHT toL PLAN CHECK NO. O�d
USE ZONE _ ��� (�6�� DEVELOPMENT NO PLAN CHECK FEES $