HomeMy WebLinkAboutXC2022-1878 - Permit ApplicationPrint Foam Worksheet for Combo Building & Solar Permit Application ��°.
COmm'I [ Residential City of Newport Beach - Building Division LI S
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL Ve
Building ❑Grading ❑Drainage j jElec Mech Plum Cu Yd Cut Cu Yd Filll l
Project Address (Not mailing address) C Flood ❑ Fire [j Liq [ Landslide l N/A Floor
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Description of Work i
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# StoriesIki # Units (if Res)�l
New/Add SF� 1 Remodel SF L GarValuation S
9 4 % Iage/New/Add Material/Labor
OWNER'S NAME Last
First
Owner's Address ral — -- —
Owner's E-mail Address
City -- I State _/ �I
I � � ZIP FqiT 17 TelephoneW /J
APPLICANT'S NAME Last First
Applicant's Address - Applicant's E-mail Address
City //i.�,��.�
� �(�' State C� I Zip AZ i77, Telephone
ARCHITECT/DESIGNER'S NAME Last
�)\ (% ',� First Lic, No. �. Llt ��(
Architect/Designers Address Architect/Designers E-mail Address
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City_State ZIP 4g2G001 Telephone 9 Cf —�V-- ?—G�
ENGINEER'S NAME Last First —
Engineer's Address Engineer's E-mail Address
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City .---- _- -- State Zip [:— Telephoned! - ---
CONTRACTOR'S NAME/COMPANY U � P !'(i Lic.No. Q67s9r Classr(3
Contractor's Address Contractors E-mail Address
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City 1-J-V�it� State C_--j Zp rIZ(� 1 Telephone -
SETBACKS REAR SETBACKS FRONT PERMIT NO. XC 20Z 1 a7g
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.1PC't6LZ• / O'
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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