HomeMy WebLinkAboutXR2022-2735 - Permit ApplicationL `Print Form Worksheet for Combo Building &s Solar Permit Application o�rEWPORe
Comm] /Residential City of Newport Beach - Building Division NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
?eBuilding Grading [—Drainage F_ Elec r Mech Plum Cu Yd cut Cu Yd Fill
Project Address (Not mailing address) f— Flood r Fire F_ Liq Landslide F_N/A Floor Suite No
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Description of Work
Use F—Const Type F-7
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# StoriesF� # Units (if Resf
Valuation $
Material/Labor
New/Add SF Remodel SF
Garage/New/Add
OWNER'S NAME Last L s
First C:l ++qf
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Owner's Address
Owner's E-mail Address
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City /� �'''vP��_ _ _ _ State C1A. Zip[ / Z46in, TelephoneFT j-_ 3 3-773 Z p
APPLICANT'S NAME Last �
First
Applicant's Address
Applicant's E-mail Address
2
City l—�t._GL� _ a"fL 2a�' State C yc�
Zip 3 Telephone
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Arch itect/Desig nids Address
F7.
Architect/Designer's E-mail Address
Ci State �—
Zip �— Telephoned
ENGINEER'S NAME Last
FirstF. Lic. No,
Engineer's Add ess
Engineer's E-mail Address
Cit State
Zip Telephone
CONTRACTOR'S NAME/COMPANY fn� �, / _ / Ze if K r BLic. No. q� ?7�ClassF
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Contractor's Address
Contractor's E-mail Address
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City.�� /`S �.. State Fe
Zip e? 2_6;,, Telephone Fi 147 -,02 ? r -3 rffl'�)
SETBACKS REAR SETBACKS FRONT
PERMIT NO. 'MZO Z2--Z7-7
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $