HomeMy WebLinkAboutXR2022-2467 - Permit Application1_ PrinlForm I Worksheet for Combo Building & Solar Permit Application
F_ Comm'I F_ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F-Building r Grading F—Drainage r Elec FMech F= Plum CuYdCut
Project Address (Not mailing address) F Flood F Fire F— Liq r Landslide
Cu Yd Fill
rN/A Floor
-2_C �3E 7 Lax Y ! zac
-
)escription of Work
Use
;> y_5
New/Add SF F3I/ Remodel SF 7— Garage/New/Add F
OWNER'S NAME Last (�
First
Suite No
ConstType F_
# StoriesFT # Units (if Res)F—
Valuation $ 7.se nc.
Material/Labor
Owners Address /� Owner's E-mail Address
G'. �r/»~z.�t Y - /N; /. )i'y CJ
City ✓�/i. ni `icit State E-79- Zip�i-z, - Telephone 7/--/ 7 >—�-6SY6
_. l � EC%C1 _ I___..
APPLICANT'S NAME Last
Applicant's Address
City ��' o ?oc� r r}cN State Gr�
ARCHITECT/DESIGNER'S NAME Last
ArchitecUDesigner's Address
Cit—
yG(wJ State
First I , D
Applicant's E-mail Address
Zip 9z �U Telephone j/ iy _ 6 5
First l U;. 71 Lic. No.
Architect/Designer's E-mail Address
ZiP / Telephone A?(). 35 k
ENGINEER'S NAME Last First F
/}s2K"tS �ZIi Lic. No.
Engineer's Address Engineer's E-mail Address
City !D� State Fq Zip l2,11V _ fTelephone F9``cj _ 7, 7170
CONTRACTOR'S NAME/COMPANY PC Lic No. E��</ Classy
Contractor's Address Contractor's E-mail Address
l'E%( �`r�f'r!}n� Lti'r3y �/� i$Y'h�Cz�`+�/ �� D;3•`+/,vim-Cc�-t
City ! v c�,��..t/ State ZiP Telephone9�'. 7
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
PERMIT NO. X"G22 -Z1/61%
PLAN CHECK N0.
PLAN CHECK FEES $