HomeMy WebLinkAboutX2022-1754 - Permit Application�, rPnntForm,,i Worksheet for Combo Building & Solar Permit Application o4�EwPo
❑ Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF,SUBMIT�TAL—
Building ❑Grading
❑Drainage BElec ❑Meth ®PIUm CuvdCut F7 CuvdFill l
Project Address (Not.mailing address) ❑ Flood ❑ Fire ❑'Liq ❑ Landslide ❑N/A Floor Suite No
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Description of Work
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Use `Const Type l� ('j
# Stories .# Units (if Res)C
CZY
YCC�
New/Add SF
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Remodel SF 0. Garage/New/Add( I
Valuation $ ,
Material/Labor
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OWNER'S NAME
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Last �� vLfi)t First
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I l 11
Owners Address
owner's E-mail Address
State Zip I Telephone
APPLICANT'S NAME
Last 341 First W
Applicant's Address
Applicant's E-mail Address
City
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State Zip G Telephone
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ARCHITECT/DESIGNER'S NAME Last
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1 First TLfA n I Lic: No.
Archite UDesigner's Address-
Architect/Designer's E-mail Address
CityQj ,
State C Zip �•� Telephone
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ENGINEER'S NAME
Last First Lic.No.�
Engineer's Address
Engineer's E-mail Address
State 17 ZipI Telephoned
City
Class
CONTRACTOR'S NAME/COMPANY . V) G�?t �� c) lk Lic. No.,'y
Contractots Address
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Contractor's E-mail Address01
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City
State Zip. Tele�t&i phone nj • t
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SETBACKS REAR
SETBACKS FRONT PERMIT NO. YZ4-�Z Z 76L/
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. jU
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $