HomeMy WebLinkAboutPV2022-0307 - Permit ApplicationL fnntForm j Worksheet for Combo Building & Solar Permit Application U?
City of Newport Beach - Building Division
(- Comm'] (- Residential '
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAI
F-Building I -Grading F-Drainage F-Elec F-Mech FPlum Cu Yd Cut Cu Yd Fill
Project Address (Blot mailing address) r Flood F- Fire Liq F- Landslide F_N/A Floor Suite No
Description of Work
Use F—ConstType F_
il
# Storiesr— # Units (if Res)L�
Valuation $
Material/Labor
New/Add SFF,
Remodel SFF
Garage/New/Add �—
Lam) r L/
OWNER'S NAME Last First
Owner's Address
Owner's E-mail Address
City State L Zip Telephone7---
APPLICANT'S NAME Last
First I '
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Applicant's Address
Applicant's E-mail Address
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City State
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Zip U7 u � r Telephone C� `7/' ,_' T✓ - `! �a � �.
ARCHITECT/DESIGNER'S NAME Last First F—Lic. No. F_—
Architect/Designer's Address
Architect/Designer's E-mail Address
City State L
Zip [— Telephone —
ENGINEER'S NAME LastF®
First Lic. No.7—
Engineer's Address
Engineers E-mail Address
City State
Zip �— Telephone��
CONTRACTOR'S NAME/COMPANY i tt
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{tJC'✓r . LicNo. � Class
Contractor's Address
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Contracto 's E-mail Address
City J2C t nK L State C-A
Tele hone i.
p Zip
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SETBACKS REAR SETBACKS FRONT
PERMIT NO PV 7v(rL� L �C� 3� 7
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK N0. �I(02z - Z3%
USE ZONE DEVELOPMENT NO _
PLAN CHECK FEES $
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