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HomeMy WebLinkAboutX2022-1697 - Permit Application (3)Print Form I Worksheet for Combo Building & Solar Permit Application o��EWPoR@ j- Comm'I (— Residential City of Newport Beach - Building Division xaoo ,C ­ NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL j- Building F-- Grading [—Drainage F Elec r Mech j— Plum Cu Yd Cut Cu Yd Fill F Project Address (Not mailing address) I_ Flood F_ Fire (— Liq j— Landslide C_N/A Floor Suite No _l F6- 60-1 Drive-, Description of Work Use Const Type # Stories # Units (if Res)[_ fi p lL- Valuation $ New/Add SF Remodel SF Garage/New/Add �� Material/Labor OWNER'S NAME Last 1 First Owner's Address Owner's E-mail Address F_ City VY�B— State Zip �G� atF�©{v Telephone �7 APPLICANT'S NAME Last M C r`7 First I� "l Applicant's Address Applicant's E-mail Address kgn,,�ttah,69 ap�cok_ City ��,h `f vl Ck .7�jv'aka State r Zip ��`��� Telephone Q 2 First y J(' Lic. No. ARCHITECT/DESIGNER'S NAME Last Dd6 1,1 Architect/Designer's Address Architect/Designer's E-mail Address City � � �,IP44,,m01A � * 3m F_ t�y� ` Vv State Zip /��1 /�' Telephon41, I AvrdI� � 1 l Go 7t� "' 5 ENGINEER'S NAME Last First Lic. No.�� ux— Engineer's Address Engineer's E-mail Address 3 City R� C State Zip T//O / Telephone CONTRACTOR'S NAME/COMPANY Lic. No. ti(( Class 1 0� Sava, �c�z��`� Col�r. Contractor's Address Contractor's E-m it Address City I j� �`� y, State C� Zip [j� b Telephone—� SETBACKS REAR SETBACKS FRONT PERMIT NO. SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. USE ZONE DEVELOPMENT NO PLAN CHECK FEES $