HomeMy WebLinkAboutXR2022-2030 - Permit ApplicationI Print Form Worksheet for Combo Building & Solar Permit Application
f— Comm] F_ Residential City OT Newport Beach - Building Division 0�
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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f—Building F_ Grading F-Drainage F_ Elec F_ Mech Plum Cu Yd Cut F Cu Yd Fill I
Project Address (Not mailing address) [_ Flood F_ Fire [_ Liq [— Landslide FN/A Floor Suite No
....... ... 177 F.- . ... ...
.. . ........ . ...... .... . ........... . . I -
Description of Work
Use F Const Type
. ...... # StoriesF_ # Units (if Res)F—
. ........... . . .. . ...... ..
Valuation $
New/Add SF Remodel SF Garage/New/Add Material/Labor '-J6 t00 C)
OWNER'S NAME Last � r_C 1^ e_ First F,
Owner's Address Owner's E-mail Address
n
City State
Zip Telephone 00� 5 - ----- PL(C�
APPLICANT'S NAME Last i
First
... ... .. ........... ...... . . ........ ..
Applicant's Address Applicant's E-mail Address
/-
. ...... . ..... ... . .........
city State Zip qqjo,63 ! Telephone
ARCHITECT/DESIGNER'S NAME
LasttT11,1-0VV S 0 First
Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City 77.� State zip Telephone
ENGINEER'S NAME
Last First Lic. No.
Engineer's Address 4-- Engineer's E-mail Address
. ... ....... .. ........... . . . ... .....
City State -7 Zip Telephone
CONTRACTOR'S NAME/COMPANY 4S—t ftjkj—� I 0,5C,0jpL Lic. No. Class
. ........... .. . FT97-
Contractor's Address Contractor's E-mail Address s� _Z_ S__(23_(0
.. . . .... . . . ...... . . .....
City /v State zip F117665'
......... . . Telephone
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
PERMIT NO.Xli?�4t+2'�Z-030
PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $