HomeMy WebLinkAboutXC2022-1947 - Permit ApplicationL PrintFoPm j Worksbeet for Combo Building & Solar Permit Application
Comm'I F Residential
City of Newport Beach - Building Division uZE N
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL !
Building Grading f—Drainage r Elec F_ Mech f— Plum Cu Yd Cutl Cu Yd Fill
Project Address (Not mailing address) (_ Flood F_ Fire F_ Liq F_ Landslide
f_N/A Floor
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Suite No
F_—
Description of Work Use � Const Type
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of # Stories 1 # Units (if Res)F-
- 12 ........�/ _ -'`
Valuation $
New/Add SF Remodel SF Garage/New/Add �� Material/ ba or 101 000
OWNER'S NAME Last ��ec,�� / j ( First
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Owner's Address Owner's E-mail Address
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City State
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__..- _.,_.. �_ Zip GI Tele hone /
APPLICANT'S NAME Last ' ` First
Applicant's Address
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Cit i- .. '. r G� "? State
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C �_ _ 7A__._.
ARCHITECT/DESIGNER'S NAME Last
Architect/Designer's Address
FCity State
Applicant's E-mail Address
Zip `�M1 Telephone
First Lic. No.
Architect/Designer's E-mail Address
Zip �— Telephone
ENGINEER'S NAME /
Last l� ro First 7-t U Lic. No.
Engineer's Address Engineer's E-mail Address
City i� T_ �_� __ State Zip 1 ���Gi Telephoned ,
CONTRACTOR'S NAME/COMPANY 1 0(c
t Lic. No. j �G� Class
Contractor's Address Contractor's E-mail Address
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City Vl� Gt� State (y' 6/4 Zip 4I Telephone �74� 72 ,� oI47
SETBACKS REAR
SETBACKS FRONT
PERMIT NO. you&- I q
SETBACKSLEFT
SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $