HomeMy WebLinkAboutX2022-0945 - Permit Application (3)Print Form Worksheet for Combo Building & Solar Permit Application �aEWPoq,
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�1- ° e City of Newport Beach - Building Division 1406
j� Comm r Residential
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL W
F_ Building F Grading sDrainage s Elec Mech F Plum Cu Yd Cut Cu Yd Fill I
Project Address (Not mailing address) [ Flood Fire F_ Liq [.' Landslide FN/AF`lo�orr Suite No
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Description of Work Use Const Type F77
# Stories # Units (if Res)[
................. _
Valuation $
New/Add SF Remodel SF I Garage/New/Add F77- Material/Labor ��� ✓
OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
City State Zip Telephone
APPLICANT'S NAME Last First
Applicant's Address
City State F
Applicant's E-mail Address
Zip Telephone
ARCHITECT/DESIGNER'S NAME Last First
Lic. No.
Architect/Designer's Address
City State
Architect/Designer's E-mail Address
__........ _ _.._ . ----- _. .
Zip Telephoned
CONTRACTOR'S NAME/COMPANY Lic. No. Class
Contractor's Address
13_� N u vn s:
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City State
SETBACKS REAR SETBACKS FRONT
Contractor's E-mail Address
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Zip 12� Uv..- Telephone[,:htA . �S3 0m
PERMIT NO. > py2 • Qlq
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO. 001 Qj .2927-
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $