HomeMy WebLinkAboutX2022-0780 - Permit Applicationprint Form Worksheet for Combo Building & Solar Permit Application Q
Comm'I F Residential City of Newport Beach - Building Division _ b�
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL Xis�
Building r Grading [-Drainage F,"Elec Mech j- Plum cu ydcutF Cu Yd Fill F
Project Address (Not mailing
address) I— Flood F Fire F- Liq I- Landslide rN/A Floor Suite No
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Description of Work
Use F Const Type F
V-cV1 r-cC 1 Ton
5V1,� SJ yae f�
# Stories #Units (if Res)
Valuation $
Material/Labor
New/Add SF F Remodel SF X� Garage/New/Add F—
OWNER'S NAME Last
First 1 U e(jy0
Owner's Address
Owner's E-mail Address
l) r rbor e e.
Q-c.
City 1\,) e , vc(4 (((T C k
State Zip 9 Z C,. (, D Telephone 4 /
APPLICANT'S NAME Last
�j C,1�(� First Sro,r,
Applicant's Address
Applicant's E-mail Address
�- C,-rw>lwell
Sep.
city r V 1 n e'
State L {{ Zip I Z (Q i Qj Telephone F trq - ( z- - 1 LA i
ARCHITECT/DESIGNER'S NAME
Last v G rn V 1 �aP \ First �zC o ��Y, Lic. No.
Architect/Designer's Address
ArchitectlDesigner's E-mail Address
City
State Zip F TelephoneF—
ENGINEER'S NAME Last
V( i/ 0 J l c, e ` First iCC iqY> t Lic. No. -i 4` 99
Engineer's Address
Engineer's E-mail Address
aL c ee*wet 1
1�VcAs)Se.I 0 P �zc�•n�T
City I Er V� n c
State F( Zip Z (0 1 Telephone 7 I� - L, Z
CONTRACTOR'SNAME/COMPANY (( �n1e (, L nE. / Lic.No. F� I la j j Class
Contractor's Address
"'� C t` Contractor's E-mail Address
City ,�
State T Zip G� ((� � (b Telephone o1TI.)-, - JLi_ 13�I 1
SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.n6flc /G
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $