HomeMy WebLinkAboutX2022-1296 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
r Comm] r Residential City of Newport Beach - Building Division L�
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building r Grading
r-Drainage F_ Elec r Mech r Plum Cu vd cuts Cu Yd Fill s
Project Address (Not mailing address) r Flood r- Fire r- Liq r Landslide FN/A Floor Suite No
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Description of Work
Use s Const Type s
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# Storiess # Units (if Res)r—
Valuation $
Material/Labor
New/Add SF �—
Remodel SF �U� 5�.� } Garage/New/Add �-
OWNER'S NAME Last First I;
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Owner's Address
Owner's E-mail Address (� ROO P/ �-P
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City / "`�U4t W�t}-�lftvl I v� State'07 Telephone Ylo 5�176 _,Y
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APPLICANT'S NAME
Last
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Applicant's Address
Applicant's E-mail Address
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City Lo� �� 4P�
State I zt't" Zip � ,!„ Telephone 3(0 ._ w-(ea'1`�
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ARCHITECT/DESIGNER'S NAME Last S� 1,4 ,� First -T Lic. No.
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Architect/Designer's Address
ArchitectIDesigner's E-mail Address
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City (��� �i3 Oh 5� State F Zip ,Z�/,`6b Telephone ?o , t� . (�,YJ'�
ENGINEER'S NAME
Last Pw�r'�i L vlr7M J 3 %role First F— Lic. No
Engineer's Address
Engineer's E-mail Address
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State �- Zip I ql�o& Telephone �j4_ gy)-72�
CONTRACTOR'S NAME/COMPANY t �\ •' 1Lr�� Lic. No. I(J�og55 Class
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Contractors Address
Contractor's
Contractor's E-mail Address,)
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City ir , 7 eat State I �V'r — Zip ,, 4 Telephone (1/0) e -17- 11-72
SETBACKS REAR
SETBACKS FRONT PERMIT NO. xZ0'j Z' I'j,ct Le
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. 1�iCo _ Zt7Z.,2
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $
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