HomeMy WebLinkAboutPV2022-058 - Permit ApplicationPrint Form
Comm'I Ei
et for Combo Building & Solar Permit Application
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City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
[;Building r Grading � ainage r Elec [— Meeh 7 Plum CuYd cut
,� Cu Yd Fill
Project Address (Not mailing address) F71 Flood Fire C Liq C Landslide FN/A' Floor Suite No
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Description of Work -- —
r Use ConstType
-{ # Stories #Units (if Res)[-!
r,
401,
New/Add SF Valuation $
Remodel SFC I Garage/New/Add Material/Labor !
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OWNER'S NAME Last fn a
1' (�G F_ /1JI First
Owner's Address
Owner's .E-mail Address
City State i zip (r r1 Telephone --
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APPLICANT'S NAME Last e%
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Applicant's Address Applicant's E-mail Address �—
City -- State ZipF7 Telephone
ARCHI CT/DESIGNER'S NAME Last
First— Lic. No.
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Architect/Designe Architect/Designer's E-mail Address
City State ZiP F Telephone-7
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ENGINEER'S NAME Last / C� A ._
6' --_- —__i First fj � f , I Lic. No. 77�
Engineer's Address Engineer's E-mail Address
City---- State I f Zip Telephone % 1_
CONTRACTOR'S NAME/COMPANY ,7S_A A4" J Lic. No. Class
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Contractor's Address Contractor's E-mail Address
—
State
F__J Zip
City — — Telephone
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SETBACKS REAR SETBACKS FRONT P PERMIT NO.
SETBACKS LEFT @ SETBACKS RIGHT
f PLAN CHECK NO.
USE ZONE F -, � - Q 06-0 DEVELOPMENT N
�)12021,, - PLAN CHECK FEES $