HomeMy WebLinkAboutXR2022-2454 - Permit ApplicationL Print Form
_J Worksheet for Combo Building & Solar Permit Application
( Comm'I
F_ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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I —Building
I—GradingF—Drainage I—Elec (—Mach F— plum Cu Yd Cut
Cu Yd Fill
Project Address (Not mailing address) F Flood F— Fire Liq F_ Landslide
-N/A Floor
Suite No
New/Add SFF_ Remodel SF I—
r---
Use I ConstType F
# Stories[— # Units (if Res)F
Valuation $
Garage/New/Add �— Material/Labo
OWNER'SNAME Last --
�LQlviSc � — First ._ �- 61,4
Owner's Address
Owners E-mail Address
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t GCK Ct'L%`' F
1�t /�I
ICI
City _Gt C� state I l . l7_
ZIP V_� Telenhon .
APPLICANT'S NAME Last
Applicant's Address
City
ARCHITECT/DESIGNER'S NAME
Architect/Designer's Address
City F_
ENGINEER'S NAME Last
lFirst f� �n
Applicant's E-mail Address
State �— Zip TelephoneF —
Last I First
Lic No.
Architect/Designer's E-mail Address
State F Zip TelephoneF—
First I Lic. No,��
Engineer's Address Engineer's E-mail Address
C ity
CONTRACTOR'S NAME/COMPANY
Contractor's Address
City
State F_ Zip F_ TelephoneF—
Lic. No. �— Class
Contractor's E-mail Address
State r— Zip F-- Telephone®®
SETBACKS REAR
SETBACKS LEFT
USE ZONE
SETBACKS FRONT PERMIT NO )/ -- 2' I
SETBACKS RIGHT T
PLAN CHECK NO.
DEVELOPMENT NO - PLAN CHECK FFFR R