HomeMy WebLinkAboutX2022-0813 - Permit Application (3)L Print Form 1 Worksheet for Combo Building & Solar Permit Application of
City of Newport Beach - Building Division n
( Comm'I ( Residential. NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
f—Building (—Grading j—Drainage (—Elec F_Mech
r Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) - Flood [— Fire T Liq j— Landslide F_N/A Floor Suite No
Description of Work
Use St��lr ConstTypeL v
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# StoriesF # Units (if Res)F
Valuation $
Material/Labor
New/Add SFF__ Remodel SF Z r oc c Garage/New/Add F
OWNER'S NAME Last e) n k TP r First 2 r✓-
Owner's Address
Owner's E-mail Address
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City Ccrc.. _. 1%( ,M�.r State La
Zip yzc ZS Telephone 71= ll3 Le4V
APPLICANT'S NAME Last N �o First c`
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Applicant's Address
Applicant's E-mail Address
City State L
Zij 6j2 S e` . Telephone 11 � Cl 10 Z <0 _z
ARCHITECT/DESIGNER'S NAME Last u j j
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� First LNi >° Lic.No.
Architect/Designer's Address
Architect/Designer's E-mail Address
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City PS u State L
Zip "(2 fv rj ( Telephone5v5�
ENGINEER'S NAME Last
Lic. No.
First F �—
Engineer's Address
Engineer's E-mail Address
City State F—
Zip � TelephoneF__________—
CONTRACTOR'S NAME/COMPANY �` N �\ ofS Lic. No. l�-, Z bz Class Fi3
Contractor's Address
Contractor's E-mail Address
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LC a 1 n
City I U� ,, State C,,,
Zip' `(� Telephone U t
SETBACKS REAR SETBACKS FRONT
PERMIT NO
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $