HomeMy WebLinkAboutXR2022-2156 - Permit ApplicationL_Print F07'. Worksheet for Combo Building & Solar Permit A ,7P
,�lication
F_ Comm'I F_ Residential City 01 Newport Beach - building Division V_ 1_1 t) tv
I NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
wilding F_ Grading F—Drainage F_ Elec F_ Mech F— Plum Cu Yd Cut F Cii Yrf Fill F_
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Project Address (Not mailing address) F7 Flood F_ Fire F_ Liq F_ Landslide
Description of Work
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New/Add SF Remodel SF Garage/New/Add
F_N/A Floor
Suite No
F_
Use Const Type F
# StoriesF— # Units (if Re�
s)1
Valuation $ jj
Material/Labor to/000
OWNER'S NAME Last -- First
.. . . . .......
Owner's Address Owner's E-mail Address
. ... ..... .............
city State Zip Telephone
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ARCHITECT/DESIGNER'S NAME Last First Lic. No.
IL—_ ................... . ...
Architect/Designer's Address Architect/Designer's E-mail Address
City State Zip Telephone
ENGINEER'S NAME Last First f0 Lic. No.
Engineer's Address Engineer's E-mail Address
ID I
... ..........
City State c zip C�� Telephone
CONTRACTOR'S NAME/COMPANY Lic. No. F713?60ass
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. ..... .......
Contractor's Address Contractor's E-mail Address
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city State 6� Zip Telephonel'5 5%. 25,r
F
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SETBACKS REAR I
SETBACKS LEFT (et
USE ZONE IZ-- I — (0, 0io-0
SETBACKS FRONT
SETBACKS RIGHT
DEVELOPMENT NO
PERMIT NO
PLAN CHECK NO.
PLAN CHECK FEES $
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