HomeMy WebLinkAboutPV2022-0326 - Permit ApplicationF-rint Forirrli Worksheet for Combo Building & Sol-�r Permit Ap'plicaii6h
City of Newport Beach - Building Division pNIU12.004*42(p 1 1-11'
F Comr 'I NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F-Building F_ Grading F-Drainage F_ Elec F_ Mech F- Plum Cu Yd CutF Cu Yd Fill
Project Address (Not mailing address) F_ Flood Fire F_ Liq F_ Landslide F_N/A Floor Suite No
. .. .... .. .... ........ .... . ...... . .... ..
Description of Work 4 2-
Use ConstType
# Storiesr # Units (if Res)F
..... . . .. ... .. ..... . ........ -------- ..... . ...... ... ... . . . ........... . .... . ....... . ....... .............. . ....... ... ....... - ------- -
Valuation $
New/Add SF Remodel SF .. .... . . .. Garage/New/AddF-Material/Labor
OWNER'S NAME Last First
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
r-�_& e4c, 1-/v
... .. ... ..
City State 7;7 Telephonel
F,vVV,0,1,1,41,n10---,-,1 Z i P 2- 6, k,2,
.......... . ..
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 F. Lic. No.
Engineer's Address Engineer's E-mail Address
- -- -- -1-- ..__.,....___ ............ ...........
City State Zip Telephone
CONTRACTOR'S NAME/COMPANY Lic. No. 16 Class [7 v�,
Contractor's Address Contractor's E-mail Address
.7voU atturs� C�tl
City State 0 Zip
A Telephone
F /.,,Z :3(/0
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $