HomeMy WebLinkAboutX2022-0124 - Permit Applicationt Comm'!orksheet for Combo Building & Solar Permit Application o=`W 11 PPa
j omm ; j— Residential City of Newport Beach - Building Division o
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL m
1-Building [, Grading rDrainage F Elec (-Mech f- Plum CuYdCut CuvdFill
Project Address (Not mailing address) I — Flood (' Fire F Liq F_ Landslide F_N/A Floor Suite No
Description of Work
Use ConstType
431,/c 13&e9e l--� , /
(� v T// 5 t
# toriesF_ #Units (if Res)
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New/AddSFr RemodelSFl------
Garage/New/Add r
Valuation $ I CxV
Material/Labori 1 7
OWNER'SNAME Last f 7 �i/i/ C9lf /
First
Owner's Address
Owner's E-mail Address
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City State ��- ,�
Lv l2p.✓/.a- _.-I)v9: L M r I C'.a'1- Zip & �-_ Telephoned (,�.. y j j f5 .S'/-1,13
APPLICANT'S NAME Last First
Applicant's Address
Applicant's E-mail Address
A
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City State
Zip vT&a L/- Telephone F il- / .33 3 2_�H
i
ARCHITECT/DESIGNER'S NAME Last
First F Lic. Na F—
Architect/Designer's Address
Architect/Designer's E-mail Address
City �— State r
Zip I Telephone�—
ENGINEER'S NAME Last
First Lic. No.1
Engineer's Address
Engineer's E-mail Address
City F State F_
Zip F Telephone
CONTRACTOR'S NAME/COMPANY sG N/fie K
Co AIS %Z. 7' v'C_7O'd Lic. No. Class
Contractor's Address
Contractor's E-mail Address
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ail, C.s't [— +�E.-,t=j✓�: c�e�rl7
City I tVIGJeO%e / State -
Zip 1 %2—(p`c(l Telephone?" t¢ Cffj�Z?%
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
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PLAN CHECK NO.USE
ZONE DEVELOPMENT NO
PLAN CHECK FEES $ _