HomeMy WebLinkAboutX2022-0859 - Permit Application_ Print FoL _ Worksheet for Combo Building & Solar Permit Application dEW�NT
r Comm'I j- Residential City of Newport Beach - Building Division °
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
f-Building
g rGrading Drainage r Elec F Mech j—Plum cuvdCut �
Cu Vd Fill F
Project Address (Not mailing address) [Flood r_ Fire r Liq r Landslide �N/A Floor 5-3
S Suite No
of Work
IUse ConstType
#Stories #Units (if Res)
New/Add SF�— Remodel SFF— Valuation $
Garage/New/Add r— �--
-- - - - Material/Labor
OWNER'S NAME
Last
Owner's Address
First
Owner's E-mail Address
City
State
- Zip Telephone
APPLICANT'S NAME
Last First
Applicant's Address - -- --
Applicant's E-mail Address
City
ARCHITECT/DESIGNER'S NAME
Last
Architect/Designer's Address
City
ENGINEER'S NAME
Engineer's Address
City
State — -
_ Zip �— Telephoned
State
First
- _ Lic. No. �—
Architect/Designer's E-mail Address
Zip Telephone[
Last I First
Engineer's E-mail Address
CONTRACTOR'S NAME/COMPANY
Contractor's Address
City
Lic. No.r—
State F Zip F' Telephoned
Lic. No. Class
® Contractor's E-mail Address
I
State [� Zip F' TelephoneF—
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE
DEVELOPMENT NO
PERMIT NO. X ?"OuL, - ORSm
PLAN CHECK NO. Mg'01 ZA7Z2
PLAN CHECK FFFS 59