HomeMy WebLinkAboutE2022-0325 - Permit Application�A rrint Form Worksheet for Combo Building & Solar Permit Application
( Comm'I (` Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBM►TTai���J05,6
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Description of Work
New/Add SFF � Remodel SFF___.___
Garage/New/Add
OWNER'S NAME
Last
Owner's Address
City
APPLICANT'S NAME
Applicant's Address
State F
Last 7> A d J
First ) 4e, l i
Cu Yd Cutl Cu Yd Fill
Project Address (Not mailing address) f— Flood
Fire F Liq Landslide FN/A Floor
F-
Suite No
Use r— Const Type r........._.......
# Stories[— # Units (if Res)[_
Valuation $
Material/Labor I
Owner's E-mail Address
Zip Telephone � 1
I
First
e Lk
7Y)L44(\� 12 Applicant's E-mail Address \
City
A State Zip '�� Telephone
ARCHITECT/DESIGNER'S NAME �.y.
Last D� First
Architect/Designer's Address Lic. No. l
I- .1 t , _ _� Architect/Designer's E-mail Address
City � St
ate Zip �C Jv Telephone ""), q�rv
ENGINEER'S NAME `
(�VLt
Last -
First p Q � Lic. No. /,�
Engineer's Address �`I b
Engineer's E-mail Address
City
State Zip � Telephone
CONTRACTOR'S NAME/COMPANY n-
Contractor's Address r►►QM; Lic. No. Class[-R—
Contractor's E-mail AddressAak
City �v (� �� State [CIA
f � � ��'l Zip ��'� Telephone � ..
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT PERMIT NO.
SETBACKS RIGHT
USE ZONE PLAN CHECK NO.
DEVELOPMENT NO PLAN CHECK FEES $