HomeMy WebLinkAboutXR2022-3017 - Permit ApplicationLtnntfo2M_J Worksheet for Combo Building & Soltir Permit Application
F Comm'l F�(esldential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAI
1—=Building F_ Grading
F—Drafnage f— Elec F_ Mech F— Plum Cu Yd Cut [_ Cu Yd Fill I -_
Project Address (Not mailing address) F_ Flood F_ Fire F_ Liq F_ Landslide F_N/A Floor Suite No
Description of Work
Use Const TypeF
# StoriesF # Units (if Res)
F
cr
J
•
New/Add SFF
RemodeISFF Garage/New/Add F
Valuation $
Material/Labor IF! ol WQ
OWNER'S NAME
Last First
Owner's Address
Owner's E-mail Address
it
City State Zip F L
I Telephone F71"
APPLICANT'S NAME
Last First
Applicant's Address
Applicant's E-mail Address
�j
City
State
j Zip Telephone)
ARCHITECT/DESIGNER'S NAME
Last First Lic No. 7,
it c_ t FF 7T 7, c I
Architect/Designer's Address
i 7 1
ArchitecVDesigner's E-mail Address
City State zjpl _ct Telephone
J j
ENGINEER'S NAME
Last
r\-LFirst j.Lic. No. I-.
�1_ C J
Engineer's Address
Engineer's E-mail Address
Y,
city
d
State Zip Telephone
` — --T
A
J
CONTRACTOR'S NAME/COMPANY
Lic. No. Class
Contractor's Address
Contractor's E-mail Address
City
State Zip Telephone
SETBACKS REAR
SETBACKS FRONT PERMIT NO.Y,
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $