HomeMy WebLinkAboutX2022-1532 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
1— Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F-Building rGrading F-Drainage FElec rMech Plum Cu Yd Cu Cu Yd Fillj
Project Address (Not mailing address) I- Flood 7 Fire F- Liq i Landslide I N/A Floor Suite No
aL3�
I 1
Description of Work
Use Const Type �—
# StorieUnits (if Res)
P
V f • ~'
Valuation S n
Material/Labor
New/Add SF�— Remodel SF
Garage/New/Add —
OWNER'S NAME Las; N-' W P aQn G � �� I First
Owner's Address
Owner's E-mail Address
City lv� State i
mot'
Zip ' Telephoned q I 31 1C? S-
APPLICANTS NAME Last { `S' M �t
First I R ivc" s
Applicants Address
Applicants E-mail Address
123VL �i l�pi�t/y �i'�
"� Fi�C�USSPvrTI� r-.)
city State j i (1
`-
Zip {(�� 7i q
1
ARCHITECT/DESIGNER'S NAME Last
�—Tele—phone
First Lic. No.
Architect(Designer's Address
Architect/Designefs E-mail Address
O State
riY
Zip �— TelephoneF—
ENGINEER'S NAME Last
First j 1 Lic. No.l
Engineer's Address
Engineer's E-mail Address
P�a.J �2Dv�.t�FDt-l.ow, -d- iyS
C;;y � � State C�
Zip i qj-7 d Telephone l l4 667 0�(�
CONTRACTOR'SNAME/COMPANY { NC�U-, �i7kq cptjS; Lic No. �j37(fLyD ClassiI
Contractor's Address
Contractor's E-mail Address
i )3 41 1 CN�D1U rYL
City State
Zip 0 Telephonel. 7 535� l j
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
PERMIT NO. • 4
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO __ — PLAN CHECK FEES $