HomeMy WebLinkAboutPV2022-0373 - Permit Application (2)N,Wq1_,nT/b
Print Form Worksheet for Combo Building & Solar Permit Application 04..
F Comm'I F Residential City of Newport Beach - Building DivisionNOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
( Building F_ Grading I Drainage C- Elec F_ Mech F- Plum Cu Yd cut Cu Yd Fill F
Project Address (Not mailing address) F_ Flood j— Fire F- Liq r Landslide F_N/A Floor Suite No
Description of Work
Use Const Type F
# StoriesF_ # Units (if Res)F_
.____�_.__.�._...__m._�
Valuation $
Material/Labor
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New/Add SF�— Remodel SF 4
Garage/New/Add
OWNER'S NAME Last _ --�C �__-...____-
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First ��ll
Owner's Address
Owner's E-mail Address
City 1V�/ � State (
zip 2� Telephone -
APPLICANT'S NAME Last im/ f
First
Applicant's Address
Applicant's E-mail Address)
City -�iL.-�( / ./�i State!
Zips y Telephone �J�j+, 22)
ARCHITECT/DESIGNER'S NAME Last
First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City State r
Zip Telephoned
ENGINEER'S NAME Last First F�..�� Lic. No.1 l
Engineer's Address
Engineer's E-mail Address
City State
Zip Telephone
CONTRACTOR'S NAME/COMPANY
Lic. No. rJOJ� Class �l
Contractor's Address
Contractor's E-mail Address
/ �(1� dal'%!'/ //��( .
City State
Zip �zs Telephoned
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
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PLAN CHECK NO. rC ZCZZ^ Z7��
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $