HomeMy WebLinkAboutM2022-0008 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application o4"m
F— Comm'I F_ Residential City of Newport Beach - Building DivisionJ�O� �_ ft
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAf
F_BuildingF- Grading
F—Drainage r Elec r Mech F— Plum CuvdCut F CuvdFill
Project Address (Not
mailing address) F Flood F- Fire F— Liq F- Landslide FN/A Floor Suite No
3 F-- F--
Description of Work ��
c cF �` eN
Use F Con stType �
A
�� 1Ct �wCt Z S' i er L2 / e-Cl
# Stories #Units (if Res)
Valuation $
Material/Labor
New/Add SF_
Remodel SFF Garage/New/Add F—
OWNER'S NAME
Last First
Owner's Address
Owner's E-mail Address
City I
State �— Zip F_ TelephoneF_
APPLICANT'S NAME
Last First
Applicant's Address
Applicant's E-mail Address
City I
State F_ Zip F— TelephoneF—
ARCHITECT/DESIGNER'S NAME Last First—Lic No,
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State F— Zip F_ TelephoneF_
ENGINEER'S NAME
Last First �— Lic. No.F—
Engineer's Address
Engineer's E-mail Address
City �—
State F_ Zip F_ Telephoned
CONTRACTOR'SNAME/COMPANY 4 Lic. No. 10t ;7 Class
(try �,J��cct Sic° ,
Contractor's Address
Contractor's E-mail Address
II r
C,
City Z
I \
State ct� Zip (1��� Te'le`ph`onne V9_!�'5�;�
!
SETBACKS REAR
SETBACKS FRONT PERMIT NO. I� Z072
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $