HomeMy WebLinkAboutX2022-0622 - Permit Application— Frill, FOf'" _ Worksheet for Combo Building & Solar Permit Application Fv7_
r Comm'I r" Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL jSCBuilding j- Grading I —Dr
ainage I Elec
Address (Not mailing addre;
Oescrtptlon of Work
New/AddSFF —
OWNER'S NAME
Owner's Address
Remodel SF
F Mech F Plum cu Yd cu f —
Cu Yd Fill
j Flood F Fire r Liq F Landslide XN/A
Floor Suite I
F
W "t, V�vk,zss
Garage/New/Add �—
Last
First
Owner's E-mail Address
Use Const Type
# StoriesF— # Units (if Resf
Valuation $ p
Material/Labor 85 00
City
State r----Ann F
Zip I TelephoneF�—
Last
Applicant's Address
City I
State �®—
ARCHITECT/DESIGNER'S NAME
Last
Architect/Designer's Address
C
First
Applicant's E-mail Address
zip f, TelephoneF�
First )
Lic. No. F —
Architect/Designer's E-mail Address
ty
State FZip TelephoneF_�
ENGINEER'S NAME
Last S � mti�
First F
Engineer's Address Lic. No.
Engineer's E-mail Address
city
--------------
CONTRACTOR'S NAME/COMPANY
Contractor's Address
City
State �— Zip TelephoneF —
5o mx
Lic. No. F— ClassF-
-�_ Contractor's E-mail Address
State F— Zip �—
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT
USE ZONE SETBACKS RIGHT
DEVELOPMENT NO
Telephone --
PERMIT NO, X A VZZ
PLAN CHECK NO. 1 itSq' Z(jZl
PLAN CHECK FEES $