HomeMy WebLinkAboutX2022-0731 - Permit Application-Print Form Worksheet for Combo Building & Solar Permit Application
Cityof Newport Beach - Building Division � Comm I �` Residential P 9 '
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F_Building r Grading r"Drainage F_ Elec F_ Mech l�
Plum Cu Yd Cut l Cu Yd Fill
Project Address (Not mailing address) I— Flood Fire F- Liq F_ Landslide -_N/A Floor Suite No
t 500 t 6,,
r3 - `- 3_
Description of Work
Use F— Const Type �-
1)�K
# Stories7 # Units (if Res)F—
Valuation $
Material/Labor F4roac)
New/Add SF �— Remodel SF F—
Garage/New/Add[�—
OWNER'S NAME Last 11 First
U—C O Y 0K4ci
Owner's Address
Owner's E-mail Address
1745 SkeA Ce✓t�er C)r. Zoo
Cit �
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Kt State GA
Zip c� Telephone cr�—/.
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G q 4637
APPLICANT'S NAME Last A4,4 (,,,,.First
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Applicant's Address
Applicant's E-mail Address
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YVt�vl+lri-0.kCi� �... q�i�-YC.S'Yq-�d✓I. Co
City LaF:2 [[Strcovp. State --
Zip Cf Telephone 9�-�, y�
ARCHITECT/DESIGNER'S NAME Last
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First CB,ety Lic. No.
Architect/Designer's Address
C
Architect/Designer's E-mail Address
1 7(
City 7 j�M .LW State �/fi
l 5 ���ck
Zip Tele hone
�2 7 p 7/4 46s seLoo
ENGINEER'S NAME Last �r Z
First I20 b Lic. No. 5 —QqS-S7
Engineer's Address
Engineer's E-mail Address
>e li FtvW•
���� w. Ka�ell
City ()'c, KS,!2 State Fc o
Zip 9� 67 Telephone[?/L,/
6 1 .
CONTRACTOR'S NAME/COMPANY n A Y� I t d� r 11c.
Lic No. �j Class (�
-t0 'tContractor's
Contractor's Address
zqgS6 2o-,dGa/SY��taq•S'es-ior4k',ox.co.,L
E-mail Address
City `AKQ �, •,vLBrN State
S «
a
ZiplTelephone[9SP, 47/.,$^$2�
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. CITY S (�
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $ LN