HomeMy WebLinkAboutXR2022-2081 - Permit ApplicationPnnt Form Worksheet for Combo Building Solar Permit Application
L City of Newport Beach - Building Division
r-" Comm'I
'Residential NnTF: PLAN CHECK FEES DUE AT TIME OF SUB TTAL
FBuilding F Grading F-Drainage (— Elec
P
Mech Plum Cu Yd Cut Cu Yd Fill
ect Address (blot mailing address) F7 Flood
�3ti.iU.
Description of Work
Fire [7 Liq r Landslide F_N/A
Floor Suite No
F_ F_
Use Const Type
# StoriesF_ # Units (if Res)F
Valuation $ ���
New/Add SF Remodel SF Garage/New/Add �— Material/Labor
OWNER'S NAME Last First �-
�. J- ....... _.5
Owner's Address 1 Owner's E-mail Address
F1\ k �� C ,� C�P
- - r __ __ _4_ - CO . . . . ........
City -e u, F_
State .... Zip --G� t..�_..1--- Telephone
------------------
APPLICANT'S NAME Last First r __........
.......... ...
Applicant's Address Applicant's E-mail Address
City
State C � Zip c Z Telephone `1!-i�jL-t
�l-�._..._. � �_ �-- -- � _
ARCHITECT/DESIGNER'S NAME Last First l vv - Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
Telephone
t. State ( i> Zip t i (' -- -
City es- _ I
Lic. No.
ENGINEER'S NAME Last 6n 6t«'{ First
Engineer's Address Engineer's E-mail Address
Telephone
` { State Zip
L 2 - ..._ 94
City dZ�`) . ( _- / .._......
CONTRACTOR'S NAME/COMPANY
Lic. No. �t`1 �- 5`l0 Class F6
Contractor's Address Contractor's E-mail Address
S� • 1�s. h-�� rwjv �S�c�.5.c�`"- ........ .... _............... .. _
`S' . .
City i� t �.rh State c Zip �� (Ob lv Telephone
Ir.. .. _!
SETBACKS REAR SETBACKS FRONT PERMIT NO. X�Z�ZZ..� +"
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.FxP*1?6_ ' z
USE ZONE DEVELOPMENT NO Vz$a1 001.6 PLAN CHECK FEES $