HomeMy WebLinkAboutX2022-1187 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application (JR0
r Comm I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
(_Building r Grading
17Drainage f- Elec Mech r- Plum Cu Yd Cut Cu Yd Fill
Project Address (Not address) r Flood r Firenr Liq j— Landslide F_N/A Floor Suite No
Imaailing
Description of Work
Use t ConstType F_
# Stories # Units (if Res)[—
Valuation $/
lU L � o! e
1 !
U ` q V
New/Add SFr__
Remodel SF� Garage/New/Add �
MateriaVLabor COO
OWNER'S NAME
Last First
M, 71t 3 �_e ,�
Ownnetr's Address
Owner's E-mail Address
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APPLICANT'S NAME
Last ��h • First J y
Applicant's Address
Applicant's E-mail Address
City YIA, (i h
State C,...._ Zip _ zS �.��._ Telephone 7/Y_ )-Z J -& 1 C-S-
ARCHITECT/DESIGNER'S NAME Last First - r,'
1= , r\ Lic. NO.
Architect/Designer's Address
Architect/Designer's E-mail Address 32 7t/S
City r—.—
State r Zip F_ Telephone—
ENGINEER'S NAME
Last First— Lic. No f
Engineer's Address
Engineer's E-mail Address
City �—
_ State F— Zip I Telephone—
(� Lic. No. 9 Class } F CONTRACTOR'S NAME/COMPANY +<<, / ^� j
5v1
Contractor's Address
Contractor's E-mail Address
2, i • UJ-
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City YIZI C.11l1c State �t. .. Zip 7Z�� Telephone /�-�J-�i�W3-
SETBACKS REAR
SETBACKS FRONT �w�li-C7�I/� 1 PERMIT NO.7
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. toy 1 - 2(lZ
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $