HomeMy WebLinkAboutX2022-0736 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application F_ C C-ta-A
� omm'I F_ Residential City of Newport Beach -Building Division
NOTE: PLAN CHECK FEES DUE AT TIMF nF SI IRnniTTni
F-Building F_ Grading
F-Drainage I-Elec F_Mech Plum Cu Yd Cutl Cu Yd Fill F_
Project Address Not mailing address F_ Flood r Fire [_ Li �S3
( g ) q r Landslide (-N/A��—Flo—or— Suite No
—1J
1 5-5— 51 PI ; 1 10h [sr,GL-.. I 3
Description of Work
Use Const Type �—
DEC�G,rS��
3`
# StariesF_ #Units (if Res)
1
27D ►,p
Valuation $
Material/Labor F
New/Add SFF—
Remodel SFF— Garage/New/Add �-
OWNER'S NAME
Last First
Owners Address
Owner's E-mail Address --
City �—
State F Zip [— Telephoner
APPLICANT'S NAME
Last r First
Applicant's Address
Applicant's E-mail Address
City I
State F Zip F TelephoneF—
ARCHITECT/DESIGNER'S NAME
Last First
Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City I
State �— Zip F_ Telephone F_
ENGINEER'S NAME
Last First F__ Lic. No.F—
Engineers Address
Engineer's E-mail Address
City
State [—Zip F— Telephone
CONTRACTOR'S NAME/COMPANY
Lic. No. F- Class
Contractor's Address
Contractor's E-mail Address
City
State F— Zip � Telephone��
SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $