HomeMy WebLinkAboutX2022-1424 - Permit ApplicationL Print Form_ Worksheet for Combo Building & Solar Permit Application
r- Comm'I residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Building [ Grading F-Drainage [KElec F_Mach F- Plum Cu vd Cut Cu Yd Fill
Project Address (Not mailing address) F_ Flood F- Fire F_ Liq r Landslide FN/A Floor Suite No
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Description of Work
Use F—ConstType
IF Stories #Units (if Res)
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Valuation $
Material/Labor fp UvU
New/AddSF� Remodel SFF Garage/New/AddF
OWNER'S NAME Last �}OG /}� First L (S}
Owner's Address Owner's E-mail Address
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City JfoQyy T 1��` State Zip C� U Telephone�y
APPLICANT'S NAME Last r First f-
Applicant's Address Applicant's E-mail Address
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city 7J� ir/1� State I \!T Zip '1'Z�Uy__- Telephone
ARCHITECT/DESIGNER'S NAME Last First F Lic. No
Architect/Designees Address Architect/Designer's E-mail Address
City State �— Zip F Telephoned
ENGINEER'S NAME Last F First Lic. No. F—
Engineer's Address Engineer's E-mail Address
City State �— Zip Telephoner
CONTRACTOR'S NAME/COMPANY Lic. No. F Class
Contractor's Address Contractor's E-mail Address
City State �— Zip TelephoneF_
SETBACKS REAR SETBACKS FRONT PERMIT NO. )c ZUZZ— t 4l Z
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $