HomeMy WebLinkAboutX2022-1534 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
r- Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Building Grading Drainage -Elec F_Mech Plum CuYdCut ' CuYdFill �—
Project Address (Not mailing address) F_ Flood F_ Fire F Liq, Landslide N/A Floor Suite No
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Description of Work
Use F—ConstType �—
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# Stories! 2 Units# Units (if ResJes
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Valuation
New/Add SFF Remodel SFr—
Garage/New/Add!
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Material/labors
OWNER'S NAME Last Ate' yyQRj(� L�i��� First
Owners Address
Owners E-mail Address
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City _ WC CS State
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zip I p.7 Telephone:;, 9
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APPLICANTS NAME Last { J `� 7-1��
First 1 RNA S
Applicants Address
Applicant's E-mail Address
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City (,].e �� State { e
Zip �1 `7O� Telephone,- ( g (`31
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ARCHITEC I /DESIGNER'S NAME Last!
First r r
Lic No.
ArchitecVDesigners Address
Architect(Designers E-mail Address
City State--
Zip Telephoned
ENGINEER'S NAME Last XI R o
First I & ( t� N (3,' L c. No. ��igq
Engineers Address
Engineers E-mail Address
City N State _.
Zip{, `�^�- Telephonei'�14 1 D-S�l
CONTRACTOR'SNAME/COMPANY NGvI�S�t�"'�tF /r Lic.No.F&_74[{b ClassFz
Contractors Address
Contractors E-mail Address
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City =i wA" State 1
Zip - l h7lC),!;�— Telephone!
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
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