HomeMy WebLinkAboutM2022-0016 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
F_ Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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F-Building E.Grading [,Drainage FElec F, Mech F-Plum Cu vd Cut F___l Cu Yd Fill
Project Address (Not mailing address) F_ Flood F' Fire (- Liq F' Landslide F_N/A Floor Suite No
Description of Work
Use F—ConstType
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# Stories # Units (if Res)s
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Valuation$
Material/Labor 7
New/Add SFF7777 Remodel SF
J
Garage/New/Add
OWNER'S NAME Last
First -64�
Owner's Address
Owner's E-mail Address
CityState Zip (U Telephone p �/
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APPLICANT'S NAME Last �% First
Applicant's Address
Applicant's E-mail Address
City - - -L-Y�, y1 '. State F
Zip _jj� G / Telephone p /
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ARCH ITECT(DESIGNER'S NAME Last _- _ -. g', First 17 _ - IM,21M _ Lic No. �69 �_-7
Architect/Designer's Addressff/Designer
's E-mail Address
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City ��� f•` . State I c
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Zip Q�� Telephone
ENGINEER'S NAME Last ' First Lic. No.
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Engineer's Address
Engineer's E-mail Address
City State
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Zip Telephone "
p _�"L677 p �v-_ rf7 J-rev
CONTRACTOR'S NAME/COMPANY
Lic. No. Class F—
Contractor's Address
Contractor's E-mail Address
City State F—
Zip F Telephone
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SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. `
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $