HomeMy WebLinkAboutX2022-0717 - Permit Application (2)Prin FgF;m Worksheet for Combo Building & Solar Permit Application
rl Comm'I KResidential City of Newport Beach -Building Division2022' 6�1�
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (1Not mailing address) Flood ❑Fire [� Liq F_ Landslide �N/A Floor Suite No
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Description of Work
Use L I Const Type n
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# Stories[ # Units (if Resf 7
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Valuation $) �/ D
Material/Labor
New/Add SF� � _ Remodel SF-.-�
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Garage/New/Add
OWNER'S NAME Last i First
Owner's Address
Owner's E-mail Address
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City (�I[ V I< I - �erT- 1 State l `� k-1 Zip Telephone - -- ----- -- - ---
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APPLICANT'S NAME Last First
Applicant's Address
Applicant's E-mail Address
City lf✓t' Glyn State `�
Zip �(7� Telephone
ARCHITECT/DESIGNER'S NAME Last_
First F Lic. No. f
Architect/Designees Address
Architect/Designees E-mail Address
City State �I
Zip Telephone��
ENGINEER'S NAME LastFirst
Lic. No.
Engineer's Address
Engineer's E-mail Address
- --- - .. - - ----------------- - - ----
City �— - - _- _ State � j
- - -
-- -- - ----.
Zip F_ Telephone
CONTRACTOR'S NAME/COMPANY [
V Lic. No. j( SZS j Class
Contractor's Address
Contractor's E-mail Address
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City _IJA
- N � - �[ :- - State �1
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Zip � d�j Telephone �( f
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SETBACKS REAR
SETBACKS LEFT
USE ZONE
SETBACKS FRONT
SETBACKS RIGHT
DEVELOPMENT NO
PERMIT NO. X 202%r 0717
PLAN CHECK NO.
PLAN CHECK FEES $