HomeMy WebLinkAboutX2022-0968 - Permit Application (2)PfigtForm ` Worksheet for Combo Building &Solar PTfTiinAlig(ff
Comm'I [ esidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Grading [Drainage ❑ Elec [] Mech [ Plum cued
Address (Not mailing address) ❑ Flood ❑ Fire [I Liq
of Work
GNf
IAF
New/Add SFL . RemodelSF�� Garage/New/Add
OWNER'S NAME Last /�, Q,h. t 0 _k)i�) First
Cu Yd Fill 17
[N/A Floor Suite No
I___7
F 777
Use F-7 Const Type
# Units (if Res)
I Valuation a &_ J 4
Material/Labor1S7/
/
Owner's Address t k Owner's E-mail Address
City L _(�[ State Zip QD Pq Telephone�� - 5N -
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
City _ State F_7 Zip F____— Telephoned
ARCHITECT/DESIGNER'S NAME Last �— —� First I Lic. No.
Architect(Designer's Address Architect/Designer's E-mail Address
City State F_ ___7 Zip F TelephoneL______7
ENGINEER'S NAME Last �— - First Lic. No._771
Engineer's Address Engineer's E-mail Address
City �— --- _- State F-77-7 zip[ Telephone— -- -- - - -
CONTRACTOR'S NAME/COMPANY L}L ClassF1711 �p�,
"P _ �'f�_1 Lic. No. t --J --
Contractor's Address Contractor's E-mail Address
City �1�-`- _ State L S Zip Telephone _-
SETBACKS REAR SETBACKS FRONT PERMIT NO
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $