HomeMy WebLinkAboutXR2022-2172 - Permit Application,�E°R�
Print Form Worksheet for Combo Building & Solar Permit Application o�WP
City of Newport Beach - Building Division �' ` 0).
Comm'I ( Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL �3E c�pp�P
7,BuiIding F_ Grading F—Drainage s,Elec F— Mech F— Plum CuYdCut CuYdFill
Project Address (Not mailing address) F_ Flood F Fire [_ Liq [—Landslide F_N/A Floor Suite No
Description of Work
Use F Const Type _
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# Stories # Units (if Res)F
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Valuation $
Material/Labor C)v 0 "J
New/Add SF Remodel SF l7 Garage/New/Add �®
OWNER'S NAME Last First-,^ -- — ---
Ow)ner'(s�Ad``dress Owner's E-mail Address
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City State Zip �C2 _ 0 Telephone •%
APPLICANT'S NAME Last V First fk
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Applicant's Address Applicant's E-mail Address
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City..... ... State Zi Telephone y
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ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State F_ Zip Telephone
ENGINEER'S NAME Last First j � Lic. No.
Engineer's Address Engineer's E-mail Address
_ --- - ...... .... .....................
City State Zip �s Telephoned
CONTRACTOR'S NAME/COMPANY •� � ��!�- �7 //�� ��✓%�-C���l Lic. No. Class
Contractor's Address Contractor's E-mail Address
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City h�. ._9 .... .. _._ __ _ State �— Zip �?Gj T elephone
SETBACKS REAR SETBACKS FRONT PERMIT No. /\< q ZO ZZ — If Z 7,
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. PC 2UZ2 a.-ui I
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $