HomeMy WebLinkAboutXR2022-2660 - Permit ApplicationL- PdntForm Worksheet for Combo Building & Solar Permit Application oaEW�R>a
(- Comm'I r Residential City of Newport Beach -Building Division s
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL �..
wilding [Grading F-Drainage [Elec F_Mech F-Plum Cu Yd Cutl Cu Yd Fill
Project Address
(Not mailingaddress)C Flood r Fire
2Liq r Landslide [N/A Floor Suite No
Description of Work Use F—Const Type
# Storiess # Units (if Res)F
Valuation $
New/Add SF Remodell SF �— Garage/New/Add �— Material/Labor oo�a
OWNER'S NAME Last
Owner's Address / ,f/� � (��±�, ��/-l��� fTddress
er's E-mail Address
- _11/yam Awilllzziz _ ----- _- -_ ___
City _.f-� State �- Zip TelephoneSZPl1i
APPLICANT'S NAME Last Q 0 First�/� - 7>
Appppl�icant's ddress Applicant's E-mail Address
City I - ,11�xGi% State --------
� �J�� /' Z�ipA Telephone
aR€HtfifEfil/ESIt'� Last �R T/ A� First % Lic. No. �� _77
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Architect/Designer's Addrj�QGr Architect/Designer's E-mail Address
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State Telephone'7/ _5 . s_g
GINEER'S NAM /' Last First Lic. No.F—
Engineer's Address Engineer's E-mail Address
Ci State Zi i Z 31 I`elephohe ___
CONTRACTOR'S NAME 7COMPA D b Vle?g o- Class
Coonttrracctor's Address�/l Contractor's E-mail Address
City�/ ' State Zip Telephone ���
SETBACKS REAR SETBACKS FRONT PERMIT NO. )(�2-ZJTZZ-- Z6(�o
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. (J(
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $