HomeMy WebLinkAboutXR2022-2472 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building vision
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
uilding [ Grading F-Drainage f- Elec Mech F Plum Cu Yd Cut Cu Yd Fill
Project Address (blot mailing address) F7 Flood [_ Fire r Liq F_ Landslide F_N/A Floor Suite No
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Description of Work
Use -/C+ Const Type C/-�i
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i l� 4 # Stories #Units (if Res) %
i ^' Valuation $ ,
New/Add SF Rgnaodel SF d �G" 1f tj Garage/New/Add �- Material/Labor
OWNER'S NAME
Last �' '
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Owner's Address Owner s Ermaif Ad�Yess -
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_ Zip_... __ �— Telephone
City F' - State
APPLICANT'S NAME Last i )C First
Applicant's Address Applicant's E-mail Address
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City r�_-/',G�r._ _��;✓Vtri)_ State d�.._ Zip �j`2 E/7 Telephone
ARCHITECT/DESIGNER'S NAME Last �,�. / �, /'��Z. / First C-�� •v��. Lic. No �.�
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Arch itecUDesign er's Address Architect/Designer's E-mail Address
City State , Zip Telephone
ENGINEER'S NAME Last First Lic. No.
Engineer's Address Engineer's E-mail Address
City State Zip F Telephone
CONTRACTOR'S NAME/COMPANY Lic. No. FSS 63
Class 7
Contractor's Address Contractor's E-mail Address
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City State F— Zip Telephone
SETBACKS REAR SETBACKS FRONT PERMIT N0�/
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. �(i� • ?,?j��j
USE ZONE DEVELOPMENT NO _ __�� PLAN CHECK FEES $