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HomeMy WebLinkAboutXC2022-2000 - Permit ApplicationPfint Form J for- Com boBuil-ding & Solar Permit Application PpRT [��tomm'l f Residential City of Newport Beach - Building Division XG141— ?,Ao NOTE: PLAN CHECK_ r'EES DUE AT TIME OF SUBMITTAL wilding F_ Grading f—Drainage F--Elec F,�Mech 7KUm CuYdCutF Cu Yd Fill Project Address (Not mailing address) Flood Nire Liq F_ Landslide F_N/A Floor Suite No F Ovt- Description of Work Use Const Type Fff j TER-( Q�l C- EM 6 0 L # Stories[ # Units (if Res) ... ...... . L__ TC J) New/Add SF F_ Remodel SF F, i) Garage/New/Add Valuation $ Material/Labor q Tj 0 C3 OWNER'S NAME Last First Owner's Address Owner's E-mail Address City State F_ ZiPF— TelephoneF� APPLICANT'S NAME Last First Applicant's Address Applicant's E-mail Address City State r Zipj TelephoneF7 0 ARCHITECT/DESIGNER'S NAME Last First I _ - A4(:S� Lic. No.F Architect/Designer's Address Arch itect/Designer's E-mail Address L-c"l-iLl &;Tt-4 fit o 0, C ity State ZIP Telephone ENGINEER'S NAME Last First F_ Lic. No.1 Engineer's Address Engineer's E-mail Address City F� State F Zip F Telephone CONTRACTOR'S NAME/COMPANY Lic. No. Class ty yo a %�ar0e,i tff�j Contractor's Address 0�s /71D j Contra or's E-mail Address City State Zip F Telephone SETBACKS REAR SETBACKS FRONT PERMIT NO, SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. USE ZONE DEVELOPMENT NO PLAN CHECK FEES $ V\. I- k