HomeMy WebLinkAboutX2022-1583 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division
Comm'I FJ Residential_
r NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
uilding (V Grading
/Project
r—Drainage FW Elec F— Mech
j-- Plum Cu Yd Cut Cu Yd Fill
Address (Not
mailing address) I- Flood
F_ Fire F` Liq F- Landslide F—N/A Floor Suite No
2 0
Description of Work
Use Const Type
# Stories #Units (if Res)
-
c--,
) ��
Valuation $
New/Add SF
Remodel SF / �) Garage/New/Add F
Material/Labor /V o00
OWNER'S NAME
Last IAA (' i -(// 'y
First r-7)(—!
Owner's Address
Owner's E-mail Address
City
� State F
Zip Telephonel
APPLICANT'S NAME
Last
First
Applicant's Address
Applicant's E-mail Address
City �—
State F
Zip �— Telephonel—
ARCHITECT/DESIGNER'S NAME Last �—
First I Lic. No. �—
Architect/Designer's Address
F_
Architect/Designer's E-mail Address
F_
City I
State F®
Zip I Telephone��
ENGINEER'S NAME
Last
First � Lic. No.F
Engineer's Address
Engineer's E-mail Address
City
_ State ��
Zip Telephoned
CONTRACTOR'S NAME/COMPANY
Lic. No. �� Class
0�4 )�_
Contractor's Address
Contractor's E-mail Address Y
City
State
Zip Telephone
SETBACKS FRONT
PERMIT NO. jq�LZ ��W
SETBACKS REAR
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO. r
USE ZONE
DEVELOPMENT NO
it
PLAN CHECK FEES $