HomeMy WebLinkAboutPV2022-0433 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application
Comm'I City of Newport Beach - Building Division
Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL Vaba� -u`133 U
F-Building r Grading F°Drainage F-Elec F_Mech F Plum Cu Yd Cut Cu Yd Fill
Project Address (Notmailingaddress) r_ Flood I- Fire F7 Liq j- Landslide FN/A Floor Suite No
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Description of Work
Use F—ConstType F
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# Stories7 #Units (if Res)
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Valuation $
Material/Labor
New/Add SFF_ Remodel SFF— Garage/New/Add r
OWNER'SNAME Last I Putt l r91" 1 First f ler9C y
Owner's Address Owner's E-mail Address
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City (orBna )(oP a✓l State ��2s.. Telephone
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APPLICANT'SNAME Last NEr1F5 First
Applicant's Address Applicant's E-mail Address
3/41 8/' G %ajn 5 P.4c¢/> ai' a'A41, Coop
City C0$7-19 NE-S17 State C Zip 92('2,6' Telephone yg-s33-1//33
ARCHITECT/DESIGNER'S NAME Last First F Lic. No. F
Architect/Designer's Address Architect/Designer's E-mail Address
City State F Zip F_ Telephoner
ENGINEER'S NAME Last First Lic. NoF—
Engineer's Address Engineer's E-mail Address
City State— Zip �— Telephone�—
CONTRACTOR'SNAME/COMPANY d1�gPS (G�G���L CLic. No. /06of83 Class FC /0
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Contractor's Address Contractor's E-mail Address
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City Os7wL OfSA State Cog Zip I y2C2�' Telephone y 5)'-31//33
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO,
USE ZONE DEVELOPMENT NO PLAN CHECK FEES$