HomeMy WebLinkAboutXR2022-2132 - Permit ApplicationI- Print Form Worksheet for Combo Building & Solar Permit Application
r Comm'I X'Residential City of Newport Beach - Building Division n
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding F_ Grading F,-Drainage Elec F-Mech j (Plum
Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) [ Flood F_ Fire r- Liq C- Landslide I —N/A Floor Suite No
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Description of Work Use F_ ConstType F
# Stories j # Units (if Res)F_
Valuation $ I
New/Add SF� Remode SF ti Z ( Garage/New/Add Material/Labor l
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OWNER'S NAME Last / 4n C3 First
Owner's Address Owner's E-mail Address
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City - 1 I ]_ _ - _..... State e ZiPs TelephoneF—
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address 1
City LState
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ARCHITECT/DESIGNER'S NAME First Lic. No �—
Last ,t.r�1, 1.
Architect/Designees Address Architect/Designer's E-mail Address
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ENGINEER'S NAME Last 1.,* , C�.C� First I Ur S Lic. No.�
Engineers Address Engineer's E-mail Address
CitY[ /tAj ja r: State ZipFZ� Telephone I L4a(p6 -Z�U��U
CONTRACTOR'S NAME/COMPANY
Contractors Address
Li . No. Class
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1 Contractor's E-mail Address
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EAR SETBACKS FRONT
_FT SETBACKS RIGHT
DEVELOPMENT NO
PERMIT NO. X NZGZZ s 2-13 Z
PLAN CHECK NO. pczozZ- j -4 6',J
PLAN CHECK FEES $ clot S