HomeMy WebLinkAboutXR2022-2192 - Permit ApplicationPrintForrn Worksheet for Combo Building & Solar Permit Application W�R> rrOj'le
Residential City of Newport Beach - Building DivisionNOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Grading Drainage r Elec [Mach Plum Cu Yd CutCu Yd Filldress (Not mailing address) Flood (- Fire f Liq (- Landslide I —N/A Floor2 Suite No
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Description of Work _
P( � 17, -5 rj I Use Const Type V
Imo_ -f {, T�F 11J llJad # Stories�i� #Units (if Res)
New/Add SFF �
Remodel SF�— Garage/New/Add �- Valuation Material/Laa
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OWNER'S NAME
Last
First
Owner's Address ll
Owner's E-mail Address
City _ State
_ �— j--�--
Zip Telephone
APPLICANT'S NAME Last
_. _. _. _ First '.
Applicant's Address
Applicant's E-mail Address
City
State - -
Zip �-- TelephoneF�
ARCHITECT/DESIGNER'S NAME
Last First F —
ArchitecUDesigner's Address _ Lic. No. F�
Architect/Designer's E-mail Address
City -
Zip - - -
- State �— - - -
- � TelephaneF—
ENGINEER'S NAME Last
First Lic. No.
Engineer's Address -
Engineer's E-mail Address
City State
zip TelephoneF—
CONTRACTOR'S NAME/COMPANY u
Lic No. 'OZ
Contractor's Address Classy
Contractor's E-mail Address 8T3Ud $jq36
city State F
Zip Telephone��
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT PERMIT NO.
USE ZONE PLAN CHECK NO.
DEVELOPMENT NO
PLAN CHECK FEES $