HomeMy WebLinkAboutS2022-0151 - Permit Application_Print Form — Worksheet for Combo Building & Solar Permit Application
r Comm'I F Residential City of Newport Beach - Buildin D'
F-Building
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Grading (-Drainage j-Elec j-Mech F-plum
ect Address (Not mailing add
3 o i - � / 0S7-kc && T
SPA
of Work
Cu Yd Cut Cu Yd Fill
F_ Flood r Fire r Liq F_ Landslide FN/A Floor
Suite No
4fts Link 1-d1' 66(t P' 7c:i,eIE-t"O/7- Use ConstType
New/Add SF�— Remodel SFF7—
OWNER'S NAME
Last 1 #, —z
I� x (P # Stories # Units (if Valuation $ Res)r—
Garage/New/Add �— Material/Labor
First
Owner's Address - ------
S AM Owner's E-mail Address
City — ---
- - State
_ J Zip TF
APPLICANT'S NAME Last
First
L/
3�
Applicant's Address
Applicant's E-mail Address
City - -----
State -- -
- -- Zip Tele hone—
__ -- _
ARCHITECT/DESIGNER'S NAME
Last G lSttM,¢N First E� /G
- - Lic. No. �—
Architect/Designer's Address -
Architect/Designer's E-mail Address
_7 SO 5 J In P1 T�(e ; v,-
Aj
City -- -------------
GDS �/G��(� State
- -- GiF zip
-- -._-_ _ /f O 0 4/ Telephone
ENGINEER'S NAME Last l3 t (5 CNh, e_)
--------.- ,__— First cJf21S! 0/°}%i� Lic No.
_ - - Engineer's
Address - - -
l_Zol N• TdSria Avg
City 4r/f �/ - State}
Engineer's E-mail Address
Zip / 7- g 0 r7 Telephone 7 /� - I_/ 09
CONTRACTOR'S NAME/COMPANY (J
Contractor's Address ---
Contractor's E-mail Address
City ) - _
_ State Zip Telephone�—
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE
DEVELOPMENT NO
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEES $
-�-701- tintiti.