HomeMy WebLinkAboutXR2022-2530 - Permit ApplicationPrint Form
-_ _ m J Worksheet for Combo Building & Solar Permit Application �EWnpaT
Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F'Building j- Grading F-Drainage j- Elec r Mach Plum
Cu Yd Cut � Cu Yd Fill
FProject Address (Not mailing address) F_ Flood r Fire f Liq f-- Landslide rN/A Floor Suite No
Description of Work
Use F—ConstType�
# StoriesF # Units (if Res)F-
---- -
___ GWl
New/Add SF7— Remodel SF�— Garage/New/Add F— Valuation $
- - - - - Material/Labor
OWNER'S NAME Last
First
Owner's Address - - -
Owner's E-mail Address
City State �—
Zip F— Telephone�-
- - - -
APPLICANT'S NAME Last
First
Applicant's Address Applicant's E-mail Address
City
St t _..._.. -
ARCHITECT/DESIGNER'S NAME
Architect/Designer's Address
Last
a e Zip 1— Telephonel
City State �—
ENGINEER'S NAME Last F_
Engineer's Address
City State
CONTRACTOR'S NAME/COMPANY F—
Contractor's Address
First
Lic. No. �--
Architect/Designer's E-mail Address
ZIP �— Telephone) ---
First
Engineer's E-mail Address
ZIP �— TelephoneF
Lic No.F�
Lic No. ��j—, Class
Contractors E-mail Address �13� T
1 3 0
City State �- Zip Telephone
to3L2,3
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK
USE ZONE DEVELOPMENT NO TFIS