HomeMy WebLinkAboutX2022-0430 - Permit Application_Print Foam Worksheet for Combo Building & Solar Permit Application ORT
City of Newport Beach - Building Division j—Comm'I ( Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
[Building E. Grading rOrainage [Elec EMech (—Plum cu vd cut[- Cu Yd Fill
Project Address (Not mailing address) E Flood E Fire E Liq E Landslide EN/A Floor Suite No
s ��rdf6'n LAV C C �'
Description of Work
Use F Const Type
# Stories # Units (if Res)F_
0 d�
Valuation $ FHsl000
Material/Labor
New/Add SF� Remodel SF� Garage/New/Add
OWNER'S NAME Last T�°mFirst d y
Owner's Address Owner's E-mail Address
City State w Zip �' Telephoned
APPLICANT'S NAME Last �^ a
I QY�"IS First r7,c4a/
Applicant's Address Applicant's E-mail Address
City State Zip Telephone 9Hq- 34q-S33 g
ARCHITECT/DESIGNER'S NAME Last _ First F_.
Lic. No.
Architect/Designees Address ArchitectlDesigner's E-mail Address
City State F—Zip Telephone
ENGINEER'S NAME Last 01 /✓I L First Q ( Lic. No. C 29 787
Engineer's Address Engineer's E-mail Address
�.
City State Zip F__ Telephoned
CONTRACTOR'S NAME/COMPANY "l0M& ltli 61?✓c fs Lic. No. Q)2gq( Class t 17,
i3'(36077871 7-7L"3
Contractor's Address Contractor's E-mail Address
City State �— Zip Telephoned
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. O3 83 - 2,pZZ
USE ZONE DEVELOPMENT NO PLAN CHECK FEES S