HomeMy WebLinkAboutXR2022-2154 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
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j� Comm'I Residential City of Newport Beach - Building Division , PAW
NOTE: PLAN CHECK FEES DUE AT TIME OF SUB u s
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Building F_ Grading F-Drainage j'Elec ,VMech F-jPlum CuYdCut l CuYdFill F
Project Address (Not mailing address) F_ Flood F_ Fire F_ Liq F_ Landslide rN/A Floor Suite No
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Description of Work
Use Const Type F
I # StoriesI `" # Units (if Res)
Valuation $
New/Add SF Remodel SF 3 O Garage/New/Add Material/Labor t.))
OWNER'S NAME Last (k 1n M Cl � First W e CSg S Ck W\, a �-
Owner's Address Owner's E-mail Address
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City �2V`i C� _ p_C_�-zip q Telephone State �- p L 2,..f5_�" p'�{ �— o \ 641 Z 3.
APPLICANT'S NAME Last J0,rQ m j �LJ First �,.�4 a WA
Applicant's Address Applicant's E-mail Address
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1 V S\ i Y� State
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ARCHITECT/DESIGNER'S NAME Last
First P �� y (� Lic. No.
Architect/Designer's Address V c-0 V 2. C Architect/Designer's E-mail Address
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City ���C �� s State C (` Zip q 163-0 Telephone
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ENGINEER'S NAME Last First Lic. No.
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Engineer's Address Engineer's E-mail Address
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City StateF_ Zip �— Telephone
CONTRACTOR'S NAME/COMPANY �� �-r �YS Lic. No. 21 DD Class
Contractor's Address Contractor's E-mail Address
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City �V 5� St to c Zip 1 �Q_ Telephone 3 � bx £f
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SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT
SETBACKS RIGHT
PERMIT NO. X'L�/ /
PLAN CHECK NO. fiat)•
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $