HomeMy WebLinkAboutX2022-1679 - Permit ApplicationPrint Form_ Worksheet for Combo Building & Solar Permit Application
j Comm'I esidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
r uilding F_ Grading rDrainage r Elec F_ Mech j— Plum CuvdCut F_ CuYdFill F_
Project Address (Not mailing address) r Flood r Fire r Liq F_ Landslide F_N/A Floor Suite No
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Description of Work
Use F—Const Type
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# Stories #Units (if Res)
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Valuation $ Z
Material/Labor LJ%
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New/AddSF�RemodelSF�—
Garage/New/Add—
OWNER'S NAME Last ��i`
First Vn
Owner's Address
Owner's E-mail Address
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APPLICANT'S NAME Last I (T✓f� G
First C(/, f l
Applicant's Address
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Applicant's E-mail Address
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City C l/ 'Y v ( I State �—
ZIP Telephone �� 2-6',I-?] - el
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ARCHITECT/DESIGNER'S NAME Last
First F_ Lic. No. F_
Architect/Designer's Address
Architect/Designer's E-mail Address
City State F—
Zip [ Telephoned —
ENGINEER'S NAME Last
First F_ Lic. No.�—
Engineer's Address
Engineer's E-mail Address
City State �—
Zip �— Telephoned
CONTRACTOR'S NAME/COMPANY /O 1
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Contractor's Address
Contractors E-mail Address
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City H f 5 State �—
Zip �— Tele hone
17
SETBACKS REAR SETBACKS FRONT
PERMIT NO. XZOZt -16 iq ��z2-r06►
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. IbhZ" ZUZZ
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $