HomeMy WebLinkAboutF2022-0582 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application @mw ORT
F- Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F-Building F_Grading F-Drainage F_Elec rMech FPlum CuydCut F CuYdFill _I
Project Address (Not mailing address) C Flood F_ Fire j- Liq r Landslide CN/A Floor Suite No
6 9 d--
Description of Work
Use F_ ConstType F_
U S T R-t VQ I - l Z
N,6 ri S
# StoriesF_ # Units (if Res)F_
Valuation $
Material/Labor
New/Add SFF Remodel SFF Garage/New/Add F
OWNER'S NAME Last VL .First
Owner's Address CcrP°r
0 ner's E-mail Address
City State �— Zip F— Telephoner
APPLICANT'S NAME Last )�:iJi First rrjP /
Applicant's Address Applicant's E-mail Address
_ c/77 Ll ter-J ra I_ _ � (.�- — r11 t Lj r-U o Fc e J r ut-net
—------------
City l �/ ) 7110 State I EA Zip /i ICi Telephone 1 y ' -%
ARCHITECT/DESIGNER'S NAME Last First 7— Lic. No. �—
Architect/Designer's Address Architect/Designees E-mail Address
R
City State �— Zip F_ Telephoned ---
ENGINEER'S NAME Last First Lic. No.
Engineer's Address Engineer's E-mail Address
City State F Zip F----7 Telephone[—
CONTRACTOR'S NAME/COMPANY F�C� f'cGS Lic. No. 2657S� Class
_. //S
Contractor's Address Contractor's E-mail Address ,,Or5aZ vzz C 3�
City ir�G State zip j�')J C) Telephone 03 6 1� '/3_7
SETBACKS REAR SETBACKS FRONT PERMIT NO.
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SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.l -
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $