HomeMy WebLinkAboutX2022-1405 - Permit Application:E Pnnt ,Form Worksheet for Combo Building & Solar Permit Application
[; Comm'I esidential City of Newport Beach - Building Division �n /+
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL ?Vk 1
[Building r Grading EDrainage rElec �Mech
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Project Address (Not mailing address) C' Flood
[ Fire r Uq [ Landslide
❑N/A Floor
Suite No
of Work
New/AddSFF-- RemodelSFj— Garage/New/Add
OWNER'S NAME Last Iv\ U MIA First V I
Use F—ConstType C
# StoriesF # Units (if Res)
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Owner's Address Owner's E-mail Address
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city N JL �j State �� Zip & O Telephone
APPLICANTS NAME Last
Applicant's Address
City �i f t) �o�l� State
First
Applicant's E-mail Address
ZipF_ Telephone
ARCHITECT/DESIGNER'S NAME
Last I P-,J'j`JJ&#— First f?-6kJ Lic. No. L ��(C7�S
ArchitectlDesigner's Address
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City fJ L (l! POT t✓�tT State
ArchitectlDesigner's E-mail Address
Zip Z� Telephone R ¢C(q&(
ENGINEER'S NAME Last j 1-'FA, i-_1 First pc v Lic. No. �j $ 1Z
Engineer's Address
-aop- k:ne P / 5 v r I-zs Z5z;
City L Azz L 2 �-� State 7A-
Engineer's E-mail Address q
Zip Z �3CJ Telephone ���r 206 ` / Z?
CONTRACTOR'S NAME/COMPANY Lic. No. 5�G i Lr Class
Contractors Address Contractor's E-mail Address
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City ���i ( Pae State Zip C ? G.) Telephone
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SETBACKS REAR SETBACKS FRONT PERMIT NO. 8 ��
SETBACKS LEFT SETBACKS RIGHT 'PLAN CHECK NO.
USE ZONE DEVELOPMENT NO [)2( %2C , 6+,L�HECK FEES $