HomeMy WebLinkAboutX2022-0412 - Permit Application (3)" Print Form Worksheet for Combo Building $ Solar Permit Application
1- Comm'I F Residential City of Newport Beach - Building Division W0y_ -�y 1 �
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBM AL
F-Building [;Grading -Drainage F_Elec F-Mech [:Plum CuYdCut_ CuvdFill �
Project Address (Not mailing address) C Flood E Fire [ Liq F" Landslide r_,N/AFloor Suite No
2�3 Walnu� Stree�
of Work
New/Add SFF Remodel SFF Garage/New/Add
OWNER'S NAME Last Merz First
Owner's Address
2to _ Walnul IISt,eej
City �por% Renck State CQ
APPLICANTS NAME Last
Applicant's Address
I l l l E. ZD IA SI . --
City _Sighd I ti II State F5
Owner's E-mail Address
Zip
First
Use F-ConstType F—
# Storiesr— # Units (if Res)F_
Valuation $
Material/Labor
Applicants E-mail Address
pa}sy � m{ rconslr u c�son . co m
Zip Telephone IQ ( -
ARCHITECT/DESIGNER'S NAME Last First
Lic. No.
Architect/Designer's Address
City L State I—
Architect/Designees E-mail Address
Zip F— Telephone —
ENGINEER'S NAME Last First Lic. No.�;
Engineer's Address
City State 1
Engineer's E-mail Address
Zip � � Telephone —
CONTRACTOR'S NAME/COMPANY MAR �UnSi kC_b. Lic. No. c12 (o 2 Class F to C$
Contractor's Address Contractor's E-mail Address II
ri rti-_S� - UtS� @ rnTrcansiruct�'oh CU nn
City IIcI n a l N i l l State _ CR7 ZipTelephone
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
PERMIT NO.
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES S