HomeMy WebLinkAboutPV2022-0230 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
(— Comm'I Residential City of Newport Beach - Building Division �� 0 b'L�
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F-Building Grading Drainage Elec (� Mech F- Plum Cu Yd Cut l Cu Yd Fill
Project Address (Not mailing address) f— Flood F— Fire F_ Liq [_ Landslide F_N/A Floor Suite No&lq - F_
........... . . _ .. ......... .
Description of Work Use FICIP Const Type
# StoriesF� #Units (if Res)
New/Add SF17 Remodel SF Garage/New/Add �V
OWNER'S NAME Last
First
Valuation $
Material/Labor
Owner's Address Owner's E-mail Address
I� L
l.._...... _o(P� . _ _ Pa'lue -.._ . _.. ._ .._...__ . _ _..._...
State Zipeq_h�Qt1 �/��Cit
Telephone�:T
APPLICANT'S NAME �i-� — `
Last First .. d...�SN. ... __..._ __._..._ _ .. .. __._...._ .
Applicant's Address Applicant's E-mail Address
11 c ... s _ i h I (w:e C� c
City _.1 .i/ (_F'),State �- Zip 7 Telephone 714-4 /3 Q �3
ARCHITECT/DESIGNER'S NAME Last First
Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
.1 r.. 1.11 -
F--..-. - - ...r.. - .- .. - 1. .111 .... ....... .
City F State �— Zip Telephoned
ENGINEER'S NAME Last �f,(U f2 First
.� w l Lic. No.�
Engineer's Address Engineer's E-mail Address
City rr�"'._._ _.. _. State C� Zip Telephone 1 Z
CONTRACTOR'S NAME/COMPANY ? Lic. No. Class FY
t!S
Contractor's Address Contractor's E-mail Address _----------- ..........
_ .
City i ne— State I Zip `(B Telephone ?�
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
USE ZONE
SETBACKS RIGHT
DEVELOPMENT NO
PLAN CHECK NO.
PLAN CHECK FEES $