HomeMy WebLinkAboutXR2022-3103 - Permit ApplicationL Print Form..] WorksbeetIor Combo Building & Solar Permit Applicetoon �agWPpRT
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V- Comm'I ft Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMIT L
Building j� Grading Drainage r Elec j_ Mech Plum Cu Yd Cut Cu Yd Fill F
Project Address (Not mailing address) F_ Flood Fire Liq F_ Landslide f_N/A Floor Suite No
Description of Work
nst Type
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# Stories # Units (if Res)s
`'//'�n ��•� Valuation$ -
New/Add SF „�Emodel SF��Z clay Garage/New/Add �— Material/Labor Zj 3C%.
OWNER'S NAME
Last � .._. ��� G�/%'��" CfGJ First —
Owner's Address Owner's E-mail Address,
City - -- State
Zip �— Telephoned
APPLICANT'S NAME
Last /z (JA First
Applicant's Address Applicant's E-mail Address
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City 1,;!�,)4/17 State f l Zi L.
- P / Telephone .. --/
ARCHITECT/DESIGNER'S NAME /,I /
Last %� ft/r' � /' � First (�. iadt/,,') -y Lic.
Architect/Designer's Address Arch itect/Designer's E-mail Address
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City State Zip Telephone
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a ENGINEER'S NAME Last First
- _ Lic. No.
Engineer's Address Engineer's E-mail Address
City State Zip �— Telephone
CONTRACTOR'S NAME/COMPANY ►� _ I Lic. No.k6V, Class� lJ
Contractor's Address Contractor's E-mail Address
City State r..- �Zip Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO. %1�iU� 0
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK No.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $