HomeMy WebLinkAboutX2022-0123 - Permit ApplicationPrint Form X Worksheet for Combo Building & Solar Permit Application
Comm'I � 'd 2p22 - p IZ 3 City of Newport Beach - Building Division
(— esi ential
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Ft—,,<u i I d i n g F Grading
F-Drainage ec Mech 11r Plum CuvdCut F_ CuYdFill
Project Address (Not mailing address) F- Flood F_ Fire (— Liq r Landslide Floor Suite No
111 �rDE AVOV(k �Je Av2 - CA. (75 &D f
Description of Work
Use ConstType
# Stories7 # Units (if Res)[_
New/Add SFF_
Remodel SFF Garage/New/Add F_
Valuation $ T
Material/Labor
OWNER'S NAME
Last First 11
Owner's Address
Owner's E-mail Address
City ►J��QJil-�
State Cf} Zip 92�63 Telephone )7.Z, j�73q
APPLICANT'S NAME
Last i2{ (��Z First l t I (o,.,g A-N OG-L_
Applicant's Address
Applicant's E-mail Address
1172Y +n�anT�yls� 4t2rtiCC 0.�con/Ca z�t'fZo� .Ge•^-t
City rn G-)'?--
State C%(- Zip q�0/ Telephone (5&02 0 734 I
ARCHITECT/DESIGNER'S NAME Last First Lic. No. F_
I CiS c�
V
Architect/Designer's Address
Arcf itect/Designer's E-mail Address
( iiA -
City
State Zlp Telephone C f
ENGINEER'S NAME
Last /� �,� 11irst Lic. No._
6
Engineer's Address
Engineer's E-mail Address
City
State F— Zip F_ Telephoned
CONTRACTOR'SNAME/COMPANY 6�-� �� f Lic. No. g4Oy()3 Class
Contractor's Address
Contractor's E-mail Address
117zq Ma-7 ie,7-A
.D244c �j(���a�'�r�GM�.(.�✓�
City wrh fTIM
State I e Zip FqoTelephone 0-Gil' 73y 1
SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $