HomeMy WebLinkAboutPV2022-0378 - Permit ApplicationFrint l4orm
Worksheet for'Combo Buflding'& SoB--ar Permit A Acatl6n
City of Newport Beach - Building Division
Comm'I Residential Kin-= PLAN ('Ul=r'V
FEES DUE A1 TIME 0rou BIVI TA aaM,P
f—Building r Grading F-Drainage F_ Elec F_ Mech F- Plum Cu Yd Cut Cu Yd Fill F
Project Address (Not maffiraq address) I— Flood F_ Fire f— Liq Landslide F_N/A Floor Suite No
....... . .. .... ___ .. . ... ..... ... ....
Description of Work
I P V 3, SS /(--, �,/ 7,0 "
New/Add SF � Remodel SF I . ........ . . .. ...''.. Garage/New/AddF__7
Use F—Const Type F7
# StoriesF_# Units (if Resf
Valuation $
Material/Labor 1 :31 ?56)
APPLICANT'S NAME Last F/I 6.r-t First Z_(
Applicant's Addresstiv Applicant's E-mail Address
60e_ It rdoaep/e�A
City State F 6i Zip I ga gTelephoner-Y.
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
... ... __ -.1 1 -.1. I 1 1-1--.11, _ . ... ....... . . . . .......
City F_ State Zip Telephone 1.
CONTRACTOR'S NAME/COMPANY J �4 Lic. No. Class F
Contractor's Address Contractor's E-mail Address
State
F (5�F Zip TelephoneZ
City Cz,
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT
SETBACKS RIGHT
PERMIT NO.
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $