HomeMy WebLinkAboutPC2022-2967 - Permit Application�WP°Rr
L Print Form Worksheet for Combo Building & Solar Permit Application �
rl.�Comm'I (c�Residential City of Newport Beach - Building Division ;)C`?p2Z
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building F Grading Drainage Elec Mech Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) f- Flood r Firer Liq r Landslide (-N/A Floor Suite No
Description of Work 2,/ } % d+Lf 4 0i " 12 ,A
Use '/L, Const Type
it Stories # Units (if Res)7
r(7)✓eiValuation
New/Add SF�� Garage/New/Add F�
$ _ ,
Material/Labor% cA
OWNER'S,NAME Last 17,1/,,r First
Owner's Address
Owner's E-mail Address
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City State �— Zip � Telephone��
APPLICANT'S NAME -,
Last �Lf%) �. First
Applicant's Address Applicant's E-mail Address
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city �14->�G11a (�;�� State fs . _ Zip 7_764, L Telephone %7� -Z;)�o
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ARCHITECT/DESIGNER'S NAME Last % �i�U / j First `L 1 Lic. No
Architect/Designer's Address Arch itect/Designer's E-mail Address
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City �— State-_ Z' TelephoneF777 7
ENGINEER'S NAME Last First Lic. No.
Engineer's Address Engineer's E-mail Address
City State - Zip Telephone
CONTRACTOR'S NAME/COMPANY Lic. No. Class
Contractor's Address Contractor's E-mail Address
City State F_ Zip Telep ,
SETBACKS REAR SETBACKS FRONT PERMIT NO. V W ( 0
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. �{G 't,04,Z •�,�b�
USE ZONE DEVELOPMENT NO __..... �_ PLAN CHECK FEES $