HomeMy WebLinkAboutX2022-0956 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division 20 ��—
j- Comm I r Residential O
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
wilding f, Grading f -Drainage F_ Elec F_ Mech j-Plum
Project Address (Not mailing address) I- Flood F_ Fire r' Liq
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Description of Work
�a ..........
Cu Yd CutF Cu Yd Fill 1
)— Landslide [_N/A Floor Suite No
New/Add SF� Remodel SF Garage/New/Add �'
Use �, Const Type F
# Storiesr—# Units (if Res)
Valuation $
Material/Labor
4....... .... ....................... -_...__......_.._
OWNER'S NAME Last First .Jo h�
1 h - _._. ........ ..
Owner's Address Owner's E-mail Address
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................_ g _ ... _
City �ewpo State Zip Telephone
............ ...........F777
APPLICANT'S NAME
Last ---- ___ � .E'x- _.....__ First .a 1i1
Applicant's Address Applicant's E-mail Address
_....1a7 .___ Q.u"v� c m as6nry . uS Gv�j
_.__._._..._.__....__ .................
F
City ......�^�.. YYI�S.. ...... . .. . .. . ..... State �a Zip Telephone�'T�d.Z'75
ARCHITECT/DESIGNER'S NAME —
Last .91 ri � First Lic. No. ��
Architect/Designer's Address Architect/Designer's E-mail Address
... __............... ............. ... .................... ......
City State Zip �� Telephone L3q? �3l � ?S�
ENGINEER'S NAME
Last ! First
Engineer's Address
City ��� State �—
CONTRACTOR'S NAME/COMPANY
Engineer's E-mail Address
Zip
P Lic. No.
Contractor's Address
City ! _O�' %.. %�%._ S State .� Zip
SETBACKS REAR
SETBACKS LEFT
USE ZONE
SETBACKS FRONT
SETBACKS RIGHT
i
DEVELOPMENT NO
PLAN CHECK FEES $