HomeMy WebLinkAboutS2022-0072 - Permit ApplicationPnntForm r Worksheet for Combo Building & Solar Permit Application
F_ Comm'] Vresidential City of Newport Beach -Building Division
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
r—Building [7 Grading F—.Drainage I—, Elec I` Mech r7 Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) r_— Flood r— Fire F. Liq F-, Landslide FNIA Floor Suite No
k/� F77 F
of Work
New/Add SFF7777 Remodel SFF77777 Garage/New/AddF7777
OWNER'S NAME Last I T If ) v e_-4aw Ial First
Use F . ....... Const Type F77
# Storlesr # Units (if Res)7
Valuation !
Material/Labor
erI orL
1
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Owner's Address Owners E-mail Address
City State Telephone
Zip F F
APPLICANT'S NAME Last
Applicant's Address
12 . al
...........
City LLA ri-e* StatejfA- Zip
...............
First
oplican7's E-mail Address
)LI
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
1777777 F7777
Architect/Designer's Address
I
. . ........... .. ... _ ....... ............. . ... . .......... ....... ...... .... . .........
City State F777
Architect/Designer's E-mail Address
Zip ---- -- Telephonel
ENGINEER'S NAME Last First Lic. No. F7777
Engineer's Address
City F777 State F
Engineer's E-mail Address
......... .............. . .
ZipTelephoneF
-- - -------- - -------- ------
Lic. No.1171?/21!�) Class
CONTRACTOR'S NAME/COMPANY S/GcR F23
Contractor's Address
city State
Contractor's E-mail Address
V,
Zip :,3�5 Telephonel 7/&// �2 5 q3
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEF SETBACKS RIGHT 6 ; C�
,r CHECK NO.
USE ZONE OI��,( N
�) DEVELOPMENT NO V N CHECK FEES $