HomeMy WebLinkAboutXR2022-2794 - Permit ApplicationPrint Form. Worksbeet for Combo Building & Solar Permi�Application
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j— Comm] residential City of Newport Beach - Building Division x
NOTE; PLAN CHECK FEES DUE AT TIME OF SUBMITTAL vl C�(IFp RRr
r7Building F_ Grading F—Drainage r Elec F Mech F Plum Cu Yd Cut F_
Cu Yd Fill
Project Address (Not mailing address) f- Flood r Fire r— Liq F_ Landslide INN/A Floor Suite No
Description of Work Use Const Type
'l �# Stories[ # Units (if Res)
ac w. '" �n l`�� -i >o �-
Valuation $
New/Add SF Remodel SF x Garage/New/Add F Material/Labor 7, 6) C]
OWNER'S NAME Last _ _� .t_� _.. __...... First
Owner's Address Owner's E-mail Address
City 6L�+�J 4_.... L Ali State C� zip Q Telephone(��
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
City State F Zip 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 F First Lic. No.
Engineer's Address Engineer's E-mail Address
City State Zip Telephone
CONTRACTOR'S NAME/COMPANY
i�Cg--r��T, Q� Lic. No. ��1 Z(o Sl Class
F
Contractor's Add�reess _ Contractor's E-mail Address
_
............
City / e l�j� State —Y Zip 'q,2!KIWJ Telephone ql ��� -L)D''
SETBACKS REAR SETBACKS FRONT PERMIT NO. X0 zoL z Z 7V 4
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. PC ZOZL" Z65 Z
USE ZONE DEVELOPMENT NO �`LcJ2 C �� 6•Z PLAN CHECK FEES $