HomeMy WebLinkAboutX2022-1438 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application oc-"°Ra
Comm'I F_ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL L�
wilding r Grading
rDrainage N-Elec F1Wech 'Plum Cu Yd Cuts Cu Yd Fill
Project Address (Not mailing address) F_ Flood r Fire r Liq r Landslide F_N/A Floor Suite No
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Description of Work
Use FPI Const Type
# StoriesF # Units (if Res)s
(Aj l T
) `J P ty
Valuation $
Material/Labor /
New/Add SFF—
Remodel SF Garage/New/Add �—
OWNER'SNAME
Last lnVjp3r �,y,np�,�� First
Owner's Address
Owner's E-mail Address
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City
State I Zips— Telephone LLj,�,-?Zj_ .3)A?e
APPLICANT'S NAME
Last �LA11,LF First t� (�fyrL
Applicant's Address
Applicant's E-mail Address
OtP LL l;0 "A )N C.. N Er-
City State Zip F_ Telephone l L1. 35-2. -7-5Ie
ARCHITECT/DESIGNER'S NAME Last OA/AirOG4fl O First No. CZ a� 3i
Architect/Designer's Address
l �Lic.
P7I MDU N Architect/Designer's E-mail Address �1� �t
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City
State F Zip I Telephone t'
ENGINEER'S NAME
Last I �First SA mr 4j Lic No. �i72 y5
Engineer's Address
Engineer's E-mail Address
City
State Zip F Telephone GZV , 9 ZJ , ? 0 e 1
CONTRACTOR'S NAME/COMPANY Jc il�V oq 1''�� _ CC,;� S pU� CW 9j5(��(Q Class
d Contractor's Address
Contractor's E-mail Address
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City ��CRD b' t--' State Zip 3 57, Telephone (z Q2 7 00Z-.
'TBACKS REAR
SETBACKS FRONT PERMIT NO. /1 ;�Op; ;? "I el3E
TACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
)NE
DEVELOPMENT NO PLAN CHECK FEES $