HomeMy WebLinkAboutXR2022-2239 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
F_ Comm'I r Residential City of Newport Beach - Building Division ✓1 ^ \\
NOTE: PLAN CHECK FEES DUE AT TIMF nF Cl IRKAITTnI
F4uilding j— Grading F-Drainage r�lec r;"Mech Plum Cu Yd cutF- Cu Yd Fill
Project Address (Not mailing address) C Flood- Fire _ Liq r Landslide F_N/A Floor Suite No
Description of Work
Use Const Type
# StoriesFT # Units (if Res)
Valuation $
Material/Labor
New/Add SFF' Remodel SF� r Garage/New/Add a/New/Add k�
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OWNER'S NAME Last a /', ,
71 1� First
Owner's Address Owner's E-mail Address
City ! rv-_ h'° State i Zip - Telephone
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Last i`1•(�-iVA First
APPLICANT'S NAME�'c li 1
Applicant's Address Applicant's E-mail Address
i�t i • CG l��A
�hone:,?�1i5
City t \� �C _ State Ct, Telp _ ZIp � ._. `fir c � !•f
ARCHITECT/bESIGNER'S NAME - -�
Last , rt
�• _ First 1,5('L.�.l1 LicNoT
Architect/Designer's Address Architect/Designer's E-mail Address
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City , , }� State i Zip 1 n ��u� Telephone
ENGINEER'S NAME Last F� First Lic. No.1—
Engineer's Address Engineer's E-mail Address
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City F— State Zip �— Telephoner
CONTRACTOR'S NAME/COMPANY Lic. No. F— ClassF_
Contractor's Address Contractor's E-mail Address
City State—, Zip Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO. x�Q�39
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO./7C4&&,�
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $