HomeMy WebLinkAboutPV2022-0294 - Permit ApplicationL Print Form I Worksheet for Combo Building & Solar Permit Application 'g,WPpR>
F Comm'I F_ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL u
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F—Building (V Grading [7Drainage Fv Elec F_ Mech Plum
Cu Yd Cut F Cu Yd Fill
Project Address (Not mailing address) 1- Flood F Fire F_ Liq F_ Landslide I_N/A Floor
Suite No
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Description of Work
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# StoriesF_ it Units (if Res)[—
New/Add SF Remodel SFF— Valuation $
Garage/New/Add Material/Labor
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OWNER'S NAME Last
B®v%h First
Owner's Address
Owner's E-mail Address
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Tele hone
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APPLICANT'S NAME Last
First
Applicant's Address Applicant's E-mail Address
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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 Telephone
ENGINEER'S NAME LastF7--— First
_ _ _.. Lic. No.
Engineer's Address Engineer's E-mail Address
City State Zip �— Telephone -
CONTRACTOR'S NAME/COMPANY I np Lic. No. ��/19Z yI Class s,010
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Contractor's Address Contractor's E-mail Address
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SETBACKS REAR SETBACKS FRONT PERMIT NO. IVPGv - Mq
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. J!�IPW7*�