HomeMy WebLinkAboutXR2022-3164 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application SP
F_ Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
VBuilding F_ Grading F-Drainage 'YNElec F_Mech lum Cu vd Cut Cu Yd Fill
Project Address (Not mailing address) I- Flood _ Fire [_ Liq F_ Landslide F_N/A Floor Suite No
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of Work
New/Add SF / Remodel SFF— Garage/New/Add
OWNER'S NAME Last
Owner's Address OH
`3�/4,, j57jill77U%6dlA AOV
City ���`^,OJ' State Zip
APPLICANT'S NAME Last
First I/�'�
E-mail Address
Use F ConstType F
# StoriesF_ # Units (if Res)F_
Valuation $ Fixe_o
Material/LaborG
Telephone7z4- � . i7
First I irX454>
Applicant's Address Applicant's E-mail Address
City � �r�Y �� �� State L-r,' Zip 92 v- Telephone -7/, 9Z _ 16 -6 37
ARCHITECT/DESIGNER'S NAME Last I 66161%.fe4 jd 7fy First !' /L%- Lic. No. �
Architect/Designer's Address Architect/Designer's E-mail Address
L!r .11514Ae--A�v �cp�i�ry,c�caofv+�l
City U � r� � State Zip Z G C� Telephone 'r,4&- lc�
ENGINEER'S NAME Last I k6400;71, First Lic. No kY&Y
Engineers Address Engineer's E-mail Address
City Fr +If eIV j f1 State Zip i /f 1 Telephone
CONTRACTOR'S NAME/COMPANY
Contractor's Address
city
SETBACKS REAK
SETBACKS LEFT
USE ZONE
�r ��) f✓/_ J 4j1 Lic. No. Class
Contractor's E-mail Address
State I— Zip � Telephoned®
SETBACKS FRONT
SETBACKS RIGHT
DEVELOPMENT NO
PERMIT NO.
f
PLAN CHECK NO. 1 L700 /Ti
PLAN CHECK FEES $