HomeMy WebLinkAboutX2022-0473 - Permit ApplicationPrint Form J Worksheet for Combo Building & Solar Permit Application
ICity of Newport Beach - Building Division ��j -0
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Comm I I— Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTA JJ
Kuilding I— Grading rDrainage j— Elec r Mech r Plum cuedCut CuvdFill
Project Address (Not mailing address) Flood r Fire I— Liq F Landslide rN/A Floor
Suite No
21(�0 /'A4- V tSl`k_ t2(-I v E FT_
i F
Description of Work Use FT ConstType F
a o K a,3 aAtI ( v-c4 i o S oLdd I v,,t rw " I # StoriesFF # Units (if Res Valuation $
New/Add SFF Remodel SFF— Garage/New/Add Material/Labor
I
OWNER'S NAME Last rla5�( �xV k n� First
Owner's Address Owner's E-mail Address
(gZgOCnik /c 9c robo . ov5
City �G,lin �il,lrov�- _ _.. State I" Zip 9i�� - Telephone�—
APPLICANT'S NAME Last( W 1Ik;avv-j
Applicant's Address
City ES(o�n4id6 .._.. __... State 57
ARCHITECT/DESIGNER'S NAME Last I �t A,
Architect/Designers Address
302f�aw-
City 'KS tb n d 0 O _. State r [Ik
First I r.rn l^ A,
Applicant's E-mail Address
Yavil�•Ir WtlltUwtS ® ��pvicw�-� Ivlc.Gowr
Zip 9Zoy9. Telephone jcj 4t42 7i351J
First INt 1 � 1Lic. No.
Architect/Designer's E-mail Address
5;11 .19001rh e ?Vav cov tie- co ^^
Zip 42oZ9 Telephone jIPD 391 wu
ENGINEER'S NAME Last
F
'First F—
Lic No.F
Engineers Address
Engineer's E-mail Address
City
State
Zip F Telephoned -
CONTRACTOR'S NAME/COMPANY
Lic. No. F—�t{y—/
ClassF
Contractors E-mail Address
U ` L�
Contractor's Address
_
City
State F
Zip F— TelephoneF—
SETBACKS REAR
SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.
ZONE
DEVELOPMENT NO
PLAN CHECK FEES $