HomeMy WebLinkAboutX2022-1025 - Permit Applicationi Prnt Form
_ _ _____J INorksbeet for Combo Building &Solar Permit Application
7 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 r Elec
Project Address (Not mailing arlelrns
of Work
[_Mech j- Plum
Cu Yd Cutl
Cu Yd Fill
F_
`I
j- Flood r Fire f- Liq
F Landslide
F_N/A Floor
Suite No
New/Add SFF---- Remodel SFF_
OWNER'S NAME Last
Owner's Address
City
- Use Const Type
1
2 # Storiesr # Units (if Res)F—
Valuation $
Material/Labor
First l
Owner's E-mail Address
I
State �— Zip F—
APPLICANT'S NAME Last 1
Applicant's Address
city StatP �—
ARCHITECT/DESIGNER'S NAME
Architect/Designer's Address
City
ENGINEER'S NAME Last
Engineer's Address
City
CONTRACTOR'S NAME/COMPANY
Contractor's Address
Jd \ 1 J J AQ
City
Last
First I
Applicant's E-mail Address
Zip F TelephoneF
First
Lic. No. F_
ArchitecUDesigner's E-mail Address
- I
State �— Zip Telephone�—
First Lic. No.rZ"�
Engineer's E-mail Address
State �® Zip I Telephone
` Lic. No G .. (: `- f !Class .�
Contractor's E-mail Address
State Zip 1 V f �':� Telephone `' h' -
=�Z �l6 5(✓1
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. J i
USE ZONE F)FVFI OPnn FniT nin