HomeMy WebLinkAboutX2022-0628 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
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Comm'I F- Residential City of Newport Beach - Building Division x SL l
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTA
F-Building r Grading F-Drainage j- Elec r` Mech j- Plum CuvdCut j CuYdFill I
Project Address (Not mailing address) I- Flood r Fire F- Liq r- Landslide F_N/A r
Floor
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C
in of Work
New/Add SF �_ Remodel SF �(� Garage/New/Add F—
OWNER'S NAME Last P i Jet Qa(6�_ First I jt'�VY 1 %l
Suite No
F_
Use WvonstType
# Stories # Units (if Res)[_
Valuation $
Material/Labor
Owner's Address Owner's E-mail Address
State Zip Telephone T' 36 -11-0CitY
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APPLICANT'S NAME Last U)4A_ ------ First
Applicant's Address Applicant's E-mail Address
City
State M Zip b<�, Telephone q 132 -�n.- �
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ARCHITECT/DESIGNER'S NAME Last First �— Lic. No. —
Architect/Designer's Address Architect/Designer's E-mail Address
City, State Zip F TelephoneF—
ENGINEER'S NAME Last �- First F Lic. No.F
Engineer's Address Engineer's E-mail Address
City I_ State F_ Zip [_ Telephoned
1 Lic. No. I �VV J2�('I� Classl
CONTRACTOR'S NAME/COMPANY oy C A� n C
Contractor's Address U \ Contractor's E-mail Address
U hu l c(r�. h')
City �L\� G1 .Gi State- ZiP G,A 216 TelephoneFlq O
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT
SETBACKS RIGHT
PERMIT NO. X2022- blot-g
PLAN CHECK NO. 05iE? . 2PZ2-
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $