HomeMy WebLinkAboutX2022-1273 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application
F COmm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
FBuilding r" Grading r-Drainage r Elec r Mech r- Plum CaYdCut l
Cu Yd Fill
Project Address (Not mailing address) F Flood r- Fire r- Liq r- Landslide FN/A Floor Suite No
Description of Work
Use F Const Type F
# StoriesF— # Units (if Res)[_
— Valuation $New/Add SF/���Remodel (Material/LaborFGarage/New/Add T F�
OWNER'S NAME Last �j(�' N L-n /
Owner's Address r �7
city F �,, uiofil,
APPLICANT'S NAME Last ailri
First) Jq(,W
Owner's E-mail Address
Zip I "1 L4A/. r TP.lenhnna %ll /i 191-1 /
First
Applicant's Address 11 1
,5 Applicant's E-mail Address
J�1.,i/v l�/1��u1 r
City Ilk zip
Telephone 14q 't: oo
State I l ((p �4 O J
ARCHITECT/DESIGNER'S NAME j�
Last 4 R v� Y �t First I <��1 I) Lic No. F—
ArchitecUDesigner's Address ° 'u ArchitecUDesigner's E-mail Address
City [ —
State �— Zip —. TelephoneF�
ENGINEER'S NAME Last FyA eljkH
Engineer's Address r�1
City r IG'EI,McF% State F (70�
First e� i'z�-6 Lic. No. J lj.
Engineer's E-mail Address
ZiP ` 1T(11 Telephone 7��
CONTRACTOR'S NAME/COMPANY Lic No. �S(tv%j Ii� I
Class) '✓
Contractor's Addrrenssn ` Contractor's E-mail Address
`�'�n a4aA,.Vo1
Zi
Ic'1� JJJJ"`` P � c'1 Lfo LuJ`f Telephone ✓l
SETBACKS REAR
SETBACKS LEFT
USE ZONE
SETBACKS FRONT
SETBACKS RIGHT
PERMIT NO.
PLAN CHECK NO.
DEVELOPMENT NO
PLAN CHECK FEES $