HomeMy WebLinkAboutX2022-0735 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application
(- Comm'I j— Residential City of Newport Beach - Building Division t' F
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL U
Building F_ Grading F-Drainage F_Elec rMech
Plum Cu vd Cuts Cu Yd Fills
Project Address Not mailing address F Flood
J ( g )
j- Fire F_ Li Landslide F_N/A Suite
q (- Floor Suite No
l8 l57S�ter� �ok a r�
30
3 v5 t1
Description of Work
Use ConstType
# Stories # Units (if Res)s
`
1.
� bo IV
Valuation
New/Add SF7— RemodelSFF— Garage/New/Add
$
Material/Labor -itDUZ�
OWNER'S NAME Last
First
Owner's Address
Owner's E-mail Address
City State �—
Zip [_ Telephones
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City State
Zip F_ Telephone�—
ARCHITECT/DESIGNER'S NAME Last
First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City State F_
Zip F_ Telephone F_
ENGINEER'S NAME Last �—
First I Lic. No.1
Engineer's Address
Engineer's E-mail Address
City State F
Zip Telephone
CONTRACTOR'S NAMEICOMPANY
Lic. No. F Class
Contractor's Address
Contractor's E-mail Address
City State �
Zip F Telephones_
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $