HomeMy WebLinkAboutXR2022-2549 - Permit ApplicationL Print Form Worksheet for Combo Building & Solar Permit Application
F_ Comm'I F_ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F—Building F— Grading rDrainage F—Elec F`Mech j— Plum Cu Yd Cut Cu Yd Fill F
Project Address (Not mailing address) f Flood ( Fire r Liq F_ Landslide [_N/A Floor Suite No
F F
Description of Work
Use s ConstType s
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# Stories # Units (if Res)s
Valuation $ ,,
Material/Labor l p�lG
New/Add SF , jFc Remodel SFs Garage/New/Add
OWNER'S NAME Last ��C�T First
Owner's Address
Owner's E-mail Address
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City ! h �tate Zip �� TelephoneF—
APPLICANT'S NAME Last /� Z First
Applicant's Address Applicant's E-mail Address
City State Zip l l! w Telephone 9t)9-�96 z9z3
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ARCHITECT/DESIGNER'S NAME Last /! Y First Jn Lic. No.
Architect/Designer's Adddressr Architect/Designer's E-mail Address
y / /-
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City y. /��/ _ State I V� Zip � Q/ Telephone 714 6,�4—¢37j
ENGINEER'S NAME Last First Lic. Nos —
Engineer's Address , ,2fzVg_ Engineer's E-mail Address
City State F Zip F Telephone
CONTRACTOR'S NAME/COMPANYL�� Lic. No. 175% Classy
Contractor's Address Contractor's E-mail Address
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City State �— Zip /��v Telephone �lLQ Ai_ _,2
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SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $