HomeMy WebLinkAboutXR2022-2615 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application k��°'�Rr
f V<omm'I FLR6sidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTALZU
[''wilding [ Grading F-Drainage F_ Elec r Mech Plum Cu Yd Cut F_Cu Yd Fill I
Project Address (Not mailing address) [7 Flood j- Fire j_ Liq F_ Landslide I -N/A Floor Suite No
Description of Work ci(,,A /� /t s��, ��S 7/ A 70.0V
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# Stories # Units (if Res)
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lam% �-�% ��C half%'a frvS i/G .. /( '� %�rG�
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Valuation $ p C j
c7� Material/Labor / ®Q•
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New/Add SF --Rerrrtsdel SF % �- S; Garage/New/Add F
OWNER'S NAME Last /0-7111W.2�- �1 First
Owner's Address Owner's E-mail Address
city-F_ State �e - .......... _.
-� � Zip �s Telephone
APPLICANT'S NAME Last[. ` 11 /I X First I \ A
...._..._ ..
Applicant's Address Applicant's E-mail Address
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City 7,AGi7pA /eSG,4st;i� State A Zip %' a�p Telephone F
ARCHITECT/DESIGNER'S NAME Last/���'' / First ��' z) Lic. No.t
Architect/Designer's Address Arch itect/Designer's E-mail Address
City .. -State Zip Telephone
ENGINEER'S NAME Last FirstF_ Lic. No.
Engineer's Address Engineer's E-mail Address
City State F Zip Telephone
CONTRACTOR'S NAME/COMPANY Lic. lass) 42
Contractor's Address Contractor's E-mail Address
---- ------
City State F- Zip Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO. %`-'fp1i2 • ?,lo�Glr-
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. '?'UVOM
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $