HomeMy WebLinkAboutXR2022-2745 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application ���WPORr
City of Newport Beach - Building Division %�Q_
Comm'I (Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITT `✓ ��� �71-6 AL Fon.
Building [ Grading r—Drainage r Elec r Mech F— Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) F_ Flood F Fire F7 Liq r" Landslide FN/A Floor Suite No
F7__
Description of Work
Use Const Type F_
# StoriesF_ # Units (if Res)F
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Valuation $
Material/Labor 1i b 2
New/Add SF1� Remodel SF1 _
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Garage/New/Add ((—
OWNER'S NAME Last First otie,ry
Owner's Address
Owner's E-mail Address
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City �� State EA_ Zip q� -7 Telephone
APPLICANT'S NAME Last �
First
Applicant's Address
Applicant's E-mail Address
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City . (�("� �151�►v1Y.. State `„ T..
Zip gX5,30 Telephone
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
City State
Zip Telephone
CONTRACTOR'S NAME/COMPANY �u�P�riv►' �2s ��fd>^ Lic. No. ��37S1 Class
Contractor's Address
Contractor's E-mail Address
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City ��� ('=�5►vtio�^t State ( �
Zip 9a,S3O Telephone
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SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $
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