HomeMy WebLinkAboutXR2022-2231 - Permit ApplicationPrmt Form f Worksheet for Combo Building & Solar Permit Application orEW�R>
j— Comm I (— Residential City of Newport Beach - Building Division n
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
I -Building r Grading I -Drainage I- Elec j- Mech
r Plum CuYdCut cuYdFill F
Project Address (Not mailing address)
address) I- Flood I-' Fire I- Liq j- Landslide rN/A Floor Suite No
Description of Work
Use F_ Const Type F
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# Stories #Units (if Res
Valuation $
Material/Labor
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New/Add SFF__ Remodel SFF— Garage/New/Add �—
OWNER'S NAME Last ] C, �• r
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First Ghz . k
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Owner's Address
Owner's E-mail Address
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city w .. _ u L..h _. State �`/�
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Zip y2��� Tele hone b z _. 7�/
APPLICANT'S NAME Last K , �zy
First q
Applicant's Address
Applicant's E-mail Address
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City ✓� Y�j State C�
Zip g;j JC� Telephone q - zzu -
ARCHITECT/DESIGNER'S NAME Last First Lic. No. F—
Architect/Designer's Address
Architect/Designers E-mail Address
City State F—
Zip r Telephone—
ENGINEER'S NAME Last First scams Lic No. C�5&S ,
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Engineer's Address
Engineer's E-mail Address
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City ,f-y % _._ State �—
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P �� Telephone �j
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CONTRACTOR'S NAME/COMPANY
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Contractor's Address
Contractor's E-mail Address
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City �...I.'.4 State
Zip r77 j2�j Telephone 9�i,,2J-�Cl�^
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SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. a
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $