HomeMy WebLinkAboutX2022-1574 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
Cif of New ort Beach - Bu ld Division
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r Residential NOTE: PLAN CHECK FEES DUE ATTIMEOF SUBMITTAL Z�r'`y,
r Grading F-Drainage r Elec jW Mech Plum Cu Yd Cut Cu Yd Fill
Project Address I
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Description of Work
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New/Add SFr NA Remodel SF AIA Garage/New/Add
OWNER'S NAME 7
Last Lj ` First rr` , C<_
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Floor Suite No
I F_
Use Const Type
# StoriesF— #Units (if Res)r—
Valuation $ Q�
Material/Labor `4, C�
Owner's Address Owner's E-mail Address
City I /I/ i3 State F ,/ Zip �' 2-6 j Telephone `HY 7 - 776 - i�! �I J
IAPPLICANT'S NAME Last L� j� �. � First I -, ( I
Applicant's Address
City G'rl�c rq,C,fSf- State C.4
Applicant's E-mail Address
Zip rZ GEC Telephone qqq _ '7 70 -- Z7 c( Q S "
ARCHITECT/DESIGNER'S NAME Last First
Lic. No.
Arch
Architect/Designer's E-mail Address
__ACity State 7 Zip Telephone
ENGINEER'S NAME Last First �� ,- t Lic. No. 6-t7 5 4 c(
Engineer's Address
6�S z C J V t 5,-+-n,
City 1 G G kc F_,Cex,j-- State �.
Engineer's E-mail Address
Zip q'jn Telephone - j?�
�y -7 �
CONTRACTOR'S NAME/COMPANY I A'r Q l"Q;t Air-
C.c
Lic. No. S' ZS /c.j Class ?,
Contractor's Address
2c, 2Ci Vi`q C_,�
City State /a
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT
SETBACKS RIGHT
Contractor's E-mail Address
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Zip % e6' C3 Telephone �(((�' - '770-- Z Leg S
PERMIT NO.
PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $