HomeMy WebLinkAboutX2022-1571 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application (Q-40
City of Newport Beach - Building Division fit, 7aV,Comm'I (` Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL ���
F- Building F-Gradingr"Drainage rElec rMech
rPlum CuydCut F CuYdFill F
Project Address (Not mailing address) r Flood r Fire r Liq r Landslide rN/A Floor Suite No
Description of Work
Use F—ConstType
po,
# Storiesr— # Units (if Res)F—
Valuation $ r
Material/Lab
New/Add SF1_Remodel SFF Garage/New/Add F—
OWNER'S NAME Last C C {
First e —
Owner's Address
Owner's E-mail Address t
Zq `r19(,`: C,l✓ k P'K--
City �` � State <"_F
Zip F—TelephoneF
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City State c;�-
Zip 7 6j3 Telephone _M
ARCHITECT/DESIGNER'S NAME Last �
First F_ Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
C-1
City I State`—
Zip I TelephoneF—
ENGINEER'S NAME Last I
First F Lic. Nor_
Engineer's Address
Engineer's E-mail Address
� �
City F_—
State��—
Zip F Telephoned
CONTRACTOR'S NAME/COMPANY
Lic No. 2 q Class 3
Contractor's Address
Contractor's E-mail Address
City N l� State L
Zip 777 3 Telephonem
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $