HomeMy WebLinkAboutXR2022-2283 - Permit ApplicationIPrint Form Worksheet for Combo Building & Solar Permit Application q
(- Comm'I F_ Residential City of Newport Beach - Building Division W
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F'Building F_Grading
F-Drainage j_Elec rMech F-Plum Cu Yd Cuts Cu Yd Fills
Project Address (Not mailing address) F_ Flood (- Fire r Liq r Landslide I -N/A Floor Suite No
C (
Description of Work
Use Const Type s
ta
# Storiess # Units (if Res)F
Valuation $
Material/Labor �? r •" L
New/AddSFs
Remodel Garage/New/Add —
OWNER'S NAME
Last C• L First
Owner's Address
Owner's E-mail Address
City /1 C L . ;+ State F7rt Zip 1 % o y - -- Telephones—
APPLICANT'S NAME
LastFirst A
Applicant's Address
Applicant's E-mail Address
-13
City
State ( Zip l c `.. ; Telephone
ARCHITECT/DESIGNER'S NAME Last First F—
Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State �— Zip F-7 TelephoneF —
ENGINEER'S NAME
Last 1 ._ First M .I'll , Lic. No. L ,� j ;
Engineer's Address
Engineer's E-mail Address
City M, 111j � V w State C Zip (i C 't 3 Telephone T s 27,z, i 5
CONTRACTOR'S NAME/COMPANY ) ;MI,.i �� ",yU,1of� .y�,,l. ,;,,. Lic. No. ;5J7E3 Class
Contractor's Address
Contractor's E-mail Address
City I
State F Zip Telephone
SETBACKS REAR
SETBACKS FRONT PERMIT NO. 2j) 2 )j3
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $ r