HomeMy WebLinkAboutX2022-0204 - Permit ApplicationPrint Form_ Worksheet for Combo Building & Solar Permit Application ^�R.
F_ Comm'I r Residential City of Newport Beach -Building Division o ^
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL c..
F—Building F_Grading F—Drainage F-Elec F—Mech F—Plum CuYdCut F CuvdFiliF
Project Address (Not mailing address) F7 Flood r Fire j— Liq r— Landslide r_N/A�Floorr Suite No
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Description of Work
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Valuation $ F
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SFF—Remodel SF Garage/New/AddFMaterial/Labor06
OWNER'S NAME Last First
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Owner's Address Owner's E-mail Address
City State �— Zip F Telephone t
APPLICANT'S NAME Last First 0 4e
Applicant's Address p Applicant's E-mail Addr ss
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City ,Viw1� _- -- State ... Zip �� f-�j Telephone 94el AOM Z_Tf3ei
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ARCHITECT/DESIGNER'S NAME ( r
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Architect/Designer's Address Architect/Designer's E-mail Address
City j r \ KL State ('/J-- Zip I Telephone Cj
ENGINEER'S NAME Last First QtuvtCt. Lic. NO. -jC, �I CJ
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Engineer's Address 1330 `tt
Engineer's E-mail Address
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City ' Vr State �t`® Zip �—Cf Telephone 5 6
CONTRACTOR'S NAME/COMPANY Z [, D 2Cpo� �� ( �� Lic No. Class
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Contractor's Address Contractor's E-mail Address
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City J�C���1 State VI v i Zip Ro ( Telephone Az40 0l6
SETBACKS REAR SETBACKS FRONT PERMIT NO. XZ��
SETBACKS LEFT SETBACKS RIGHT KI LAN CHECK NO.
USE ZONE DEVELOPMENT NO „PLAN CHECK FEES $
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