HomeMy WebLinkAboutX2022-0208 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
Comm'I j— Residential City of Newport Beach - Building Division Xsv.Z- � 2O �
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building j— Grading [—Drainage j— Elec F_ Mech r" Plum Cu vd cut Cu vd Fill
Project Address (Not mailing address) F! Flood f— Fire F_ Liq r- Landslide j!N/A Floor FSuite
-NNo'[ -_ >> / 4 1
1, %/i i. i C ��;i ��r.e,'�_ J/ Ar
Description of Work
New/Add SF 19 Remodel SF % 00 Garage/New/Add
OWNER'S NAME
Last First
Owner's Address jOwner's E-mail Address
y
Use _ Const Type
# StoriesF # Units (if Res)7
Valuation $
Material/Labor ) ).000
ICity ,/{t e t, � �� State Zip Telephone I ` (kc-C
IAPPLICANT'S NAME Last 1 First
Applicant's Address Applicant's E-mail Address
City State `j Zip f.d(5 Telephone �ic�J -'7 11
ARCHITECT/DESIGNER'S NAME --�
Last First L�1 Lic. No. C J 0
Architect/Designer's Address Arch itect/Designer's E-mail Address ,
City � x�� '� y t� �, State ( Zip `( ZC,e>C> Telephone C,c� L�,e . j7 _' -�; ] 0
ENGINEER'S NAME Last First �— Lic. No.[
Engineer's Address Engineer's E-mail Address
City � � State F Zip �—� Telephonel—
CONTRACTOR'S NAME/COMPANY
Lic. No. ( Class
Contractor's Address Contractor's E-mail Address
0) J Lam` r z��� � ` J�x �v� ��, • �e c1� . ( ,�.�.
City State Ci Zip ' (6 � Telephone����(
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT V )�L � ob'';POMIT NO. V
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $