HomeMy WebLinkAboutXC2022-2045 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application AUDI
F- Comm'I F- Residential City of Newport Beach - Building Divisio
NOTE: PLAN CHECK FFFR nl IF AT Tenn❑ no ci IONA17TAi
r-Building F_Grading F-Drainage F_Elec F_Mech F-Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) F- Flood f- Fire F7 Liq I- Landslide FN/A Floor Suite No
Description of Work
Use ConstTypeF
# StoriesF- # Units (if Res)F—
Valuation $
Material/Labor
New/AddSF� Remodel SF�— Garage/New/Add—
OWNER'SNAME Lastll�',7T_1��J��_i
Owner's Address
Owner's E-mail Address
City t? .�ti I - L C� State �( zip Z(p cJQ TelephoneF
APPLICANT'S NAME � IC4n �' �1
Last (l] r`.�_�Y� I First W
Applicant's Address O t tk bpf 'Il lj.n�i p)Y > L_U Applicant's E-mail Address
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C;3176_ _6 - t1�U lfclY- Ave m KCt 2C���n /
City AVM j tL.f (1') State j f�� Zi �} -
P 1 zYi�� Telephone l �t�. �`� ��l /
ARCHITECT/DESIGNER'S NAME Last First �— Lic. No. F-
ArchitecUDesigner's Address Architect/Designer's E-mail Address
City State �— Zip Telephoner
ENGINEER'S NAME Last First �® Lic. No. F—
Engineers Address Engineer's E-mail Address
City State ZiP I Telephone
CONTRACTOR'SNAMEXOMPANY j_ixJl Llt Lic. No. 53_122gt! Class (lLCF-)
Contractor's Address Contractor's E-mail Address
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City State �— Zip F— Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO. " ^
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. t�'U �.4 - -7
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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