HomeMy WebLinkAboutX2022-1377 - Permit ApplicationPrint Form
(--Comml F
Worksheet for Combo Building & Solar Permit Application
Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUF AT Timm: nF ci imArr-rai
EWPp
U
F-Building r- Grading r-Drainage 174ec >\Mech "LIM Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) [ Flood 7 Fire F7 Liq j- Landslide f N/A Floor Suite No
11 I C
i
Description of Work
Use Const Type
# StoriesF # Units (if Res)
New/Add SF�— Remodel SF Garage/New/Add F—
Valuatio$
n
Material/Labor
OWNER'S NA E Last First
g -
Owner'Address ( Owner's E-mail Address
City State �— Zip Tele h
APPLICANT'S NAME Last r ��l First r
Applicant's Address Applicant's E-mail Address
Cit63S �--�DuN-m, fiPHA`�IS�rON�C'�E(�- LC�1'�
Y ®.tV G„t-1 0 State Zip Tele hone
ARCHITECTIDESIGNER'S NAME Last First �—Lic. No. F_
Architect/Designer's Address Architect/Designer's E-mail Address
City State �— Zip F Telephone
ENGINEER'S NAME Last First Lid. No.F—
Engineer's Address Engineer's E-mail Address
City I State F__ Zip �— TelephoneF—
CONTRACTOR'S NAME/COMPANY i, [Lic.Na 3 � 3 Class
N C ^
6•c I C7 �� [�� C.r �-Za
Contractor's Address _ Contractor's E-mail Address
6 3 S N.
City b���r19 State �� ZiP 76 Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO. X jtD;t D— 1 3 7 7
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. (.Z7S-oZ0o1oZ
USE ZONE DEVELOPMENT NO _ PLAN CHECK FEES $