HomeMy WebLinkAboutX2022-1476 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Aldin g j- Grading
rlDrainage �` Elec r Mech
- -
r Plum
f
Cu Yd Cutl Cu Yd Fill
roject Address (Not mailing address) r Flood
r Fire r Liq
F Landslide rN/A Floor
Suite No
)escription of Work
/
Use Canst Type
# Stories # Units (if Res
v
New/Add SF Remodel SF (Valuation$
fi 0 Garage/New/Add — Material/Labor Z S 1 t? v v
OWNERS NAME Last First 1 R73
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Owner's Address
Owner's E-mail Address
City State j`
_ I C l� ZIP�_2_6 63 Telephone � I�� Lon
APPLICANT'S NAME Last
Applicant's Address
City State �C
_ First j
Applicant's E-mail Address
ARCHITECT/DESIGNER'S NAME
Last �� t
Architect/Designer's Address
Gf/W`SL—
City State �—
Zip / Z t&3 Telephor(ejalL c� 31 3l0
�Z
First �— Lic. No.
Architect/Designer's E-mail Address
--------------------------
ZIP �— Telephoned—
ENGINEER'S NAME Last
N )-- __. _ First— LicNo.
F -
Engineer's Address Engineer's E-mail Address
City
State F— Zip �— TelephoneF
CONTRACTOR'S NAME/COMPANY c�v ✓Y� Lic No. `��
7 Jtj ClassF
Contractor's Address Contr ctor's E-mail Address
l % f r 'q rt
% �r/<ryrC'crrZ l 3 c� ��
City ?t a ^ y %j State Zip C/%(p � o Telephone
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEES $
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