HomeMy WebLinkAboutX2022-1367 - Permit Application (2)Print Form Worksheet for Combo Building & Solar Permit Application
)C City of Newport Beach - Building Division
j— Comm'I ` Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Grading Draina e F Elec Mech Plum a, vd cut F_ Cu Yd Fill
Building � g � g ��.
F_
Project Address (Not mailing address) J Flood r Fire Liq F- Landslide F_N/A Floor Suite No
�Y
a
Use Con stType
Description of Work'
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#Stories #Units (if Res)
---- Valuation $
New/Add SF
Remodel SF Garage/New/Add F Material/Labor
- --
OWNER'S NAME Last (j ( -, ['Yl First l y?
Engineer's Address
CitState
y
Engineer's E-mail Address
Zip F — Telephone
Lic. No. [OG I N7 q Class
CONTRACTOR'S NAME/COMPANY Ffit) 1 4�
Contractor's Address Contractor's E-mail Address
t
_ _ 75s�_ Zip �L� C✓ Telephone
`� � ���, � �'� !�� State
City
SETBACKS REAR SETBACKS FRONT
SETBACKS RIGHT
PERMIT NO.
PLAN CHECK NO. 2G6 • Z�2Z
SETBACKS LEFT
USE ZONE
DEVELOPMENT NO Qz222-02 q q PLAN CHECK FEES $