HomeMy WebLinkAboutXR2022-2011 - Permit ApplicationPrint Form W,o
_Print _ Worksheet for Combo Building & Solar Permit Application o4=
F_Comm'I F_ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DIIF AT TlhAr nF .ci IRRAITTAI
F-Building F_ Grading F-Drainage i-Elec rMech j° Plum CuYd Cuts Cu Yd Fill s
Project Address (Not mailing address) F Flood i- Fire F_ Liq j— Landslide F_N/A Floor Suite No
Description of Work
Use ConstType
# Stories # Units (if Res)s
Valuation $
Material/Labor
New/Add SF � s — �— �
Remodel SF Garage/New/Add I E
OWNER'S NAME Last First
1, ut L_- l� y
Owner's Address Owner's E-mail Address J
City State � Zip I— TelephoneF—
APPLICANT'S NAME Last Il t LkJ(g Z First
Applicant's Address Applicant's E-mail Address
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City-�(� State-'
Zip c� 5 Telephone c C
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ARCHITECT/DESIGNER'S NAME Last First F___— Lic. No. F_
Architect/Designer's Address Architect/Designees E-mail Address
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City State �— Zip F___— Telephone
ENGINEER'S NAME Last First �— Lic. No.s
Engineer's Address Engineer's E-mail Address
City �- State [_ Zip TelephoneF___—
CONTRACTOR'S NAME/COMPANY SYLic. No. Class ry� i��_
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Contractor's Address Contractor's E-mail Address
51�1„sfi . CDC
City I (V State c } Zip L Telephones
SETBACKS REAR SETBACKS FRONT PERMIT NO. Y �GU LI_)V{�
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $