HomeMy WebLinkAboutX2022-1135 - Permit ApplicationP(nt Fob` Worksheet for Combo Building & Solar Per
Comm'IResidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBI
Ff Building j" Grading f Drainage r Elec 17 Mech j-- Plum
- Cu Yd Cut
Project Address
Cu Yd Fill
mailing address) r Flood f—, Fire r7r Liq I— Landslide rN/A Floor Suite No
on of Work /
/77C)Z_/ //lJA
New/Add SFr Remodel
:3�l
OWNER'S NAME Last
Owner's Address
city l�G 127— aC-ACrf State
Garage/New/Add
rvon n
APPLICANT'S NAME Last I c - A S-7
Applicant's Address
64e�6 6 -
City StateF'/7A
First
Use F Const Type I V
#Stories # Units (if Resf
E
Owner's E-mail Address
ZIP � '�/ Telephone 7/Y _ Z G 7–
First I b�l&z__
Applicant's E-mail Address
Zip Telephone 71z/-2[p—�68�
ARCHITECT/DESIGNER'S NAME
Last S First L
Architect/Designer's Address <v//L
City State
Architect/Designer's E-mail Address
Zip /ZIoZ`jI Telephone17/4
ENGINEER'S NAME Last F First
Engineer's Address
City State
Lic. No. F 177Zf�
Lic. No.F7777
Engineer's E-mail Address
Zip Telephoned—,
CONTRACTOR'S NAME/COMPANY Lic No. F7—class F_
Contractor's Address
City State F --
Contractor's E-mail Address
Zip �— Telephone��
SETBACKS REAR SETBACKS FRONT /
PERMIT NO.
3'
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $