HomeMy WebLinkAboutXR2022-2675 - Permit ApplicationL._ F not form j V orksiheet for Combo Build-Ing & Soler Permit Application
F_F_�EWPORT
City of Newport Beach - Building Division ���5
Comm'[ Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL ��
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r`Building [ Grading r—Drainage (v Elec F_ Mech F— Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) f- Flood jW Fire F_ Liq f— Landslide f N/A Floor Suite No
Description of Work
New/Add SF Remodel SF�SS Garage/New/Add �—
OWNER'S NAME Last I First
Use Const Type F
# Stories[ # Units (if Res)
Valuation $
Material/Labor 1�7J .
Owner's Address Owner's E-mail Address
City State Zip �® Telephone
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
City State F Zip J, Telephone
ARCHITECT/DESIGNER'S NAME Last First
Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State Zip Telephone
ENGINEER'S NAME Last First Lic. No.
Engineer's Address Engineer's E-mail Address
City State Zip F— Telephone
CONTRACTOR'S NAME/COMPANY1�3 Lic. No.TO OClass
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Contractor's Address Contractor's E-mail Address
2,�6 C" s, PAZ �'�� S�T-E V2�'Z 47NC6 (Q Ttct.,���^��-�-�
City "-;D ut6�b State I CA Zip Zip C 56 Telephone /�4 � (�-61/
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $