HomeMy WebLinkAboutXR2022-3082 - Permit Application[ Print Fbrrn Worksheet for Combo Building & Soaar Permft Application
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F comm'l -sidential City of Newport Beach - Building Division
r NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL OTW
F.-Building f7 Grading r-.Drainage f- Elec
F_ Mech F- plum Cu yd cut F—Cu Yd Fill
Address (Not mailing address) [_ Flood I -
F,_ Fire F_ Liq F_ Landslide FN/A Floor Suite No
n of Work
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#Storiesr # Units (if Res
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New/Add SF Remodel SF
Valuation Material/Labor
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OWNER'S NAME Last First
Owner's Address
Owner's E-mail Address
city State F_ Zip J_q TelephoneF7�
APPLICANT'S NAME Last
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Applicant's Address
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City State F2✓4_
ARCHITECT/DESIGNER'S NAME Last
First L
Applicant's E-mail Address
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First F
Architect/Designer's Address
City State F_
ENGINEER'S NAME Last
Engineer's Address
City State r
CONTRACTOR'S NAME/COMPANY
E-mail Address
Zip I Telephone
Engineer's E-mail Address
ZIP Telepho
Lic. No.
Lic. No.
ClassLic. No. [q
Contractors Address
City State
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SETBACKS LEFT
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Contractors E-mail Address
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DEVELOPMENT NO '6��VZ2_-
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEES $