HomeMy WebLinkAboutX2022-0321 - Permit ApplicationF'rint Form. Worksheet for Combo Building & Solar Permit Application o��kW'°Re
[; Comm'I ' �I Residential City of Newport Beach - Building Division 1�2022- �22� '_
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL C� �,.___
Building [ Grading . [ ,Drainage `r Elec [ Mech CuYd cut Cu Yd Fill L
Project Address (Not mailing 'address) ❑ Flood F-; Fire (—� Liq [Landslide F 'N/A` Floor Suite No
Description of Work'
Use ConstType '
i
/-Ac v 6
# Stories # Units (if Res))
Valuation $ j
Material/Labor
"c
New/Add SF Ci Remodel SF ��, % Garage/New/Add—
c C
OWNER'S NAME >
Last First
Owner's Address Owner's E-mail Address
CState Zip Telephone
APPLICANT'S NAME -Last First �f�l >�L �
Applicant's Address Applicant's E-mail Address
city `f' State J._ Zip Telephone
ARCHITECT/DESIGNER'S NAME Last _ First— Lit. No.
Architect/Designer's Address j� Architect/Designees E-mail Address
City State Zip F i Telephone
.111
k, 1A
ENGINEER'S NAME Last i First o.
Engineer's Address Engineer's E-mail Address-
State—; Zip- Telephoner
CONTRACTOR'S NAME/COMPANY — Lit. No C ' j �/, Class
, ��
Contractor's Address Contractor's E-mail Address
city State Zip c.. ,, l 7 Ci 7� l- l��_c. Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. 0 ZU 22