HomeMy WebLinkAboutXR2022-2323 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application B
r Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL u
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F-Building F_ Grading F-Drainage F-Elec F-Mech F9 Plum Cu Yd Cut Cu Yd Fill F
Project Address (Not mailing address) F Flood r- Fire r Liq F- Landslide [_N/A Floor Suite No
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Description of Work
Use F_ Const Type F_
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# StoriesF_ # Units (if Res)F_
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Valuation $
Material/Labor
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New/Add SFRemodel SF7— Garage/New/Add
OWNER'S NAME Last Cc�, ><- First I I "
Owner's Address Owner's E-mail Address
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City / ' State FCVV Zip Q Telephoned -
APPLICANT'S NAME Last Ljf r�SS First
Applicant's Address Applicant's E-mail Address
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City State (J ZipF-? Telephone « �) - Y3L
ARCHITECT/DESIGNER'S NAME Last (}((`CSC First F �(-�W✓ Lic. No.�
Architect/Designees Address Architect/Designer's E-mail Address
City i Stater Zip -74�Telephone�—
ENGINEER'S NAME Last t�t i %�� c- First i C U Lic. No.
Engineer's Address Engineer's E-mail Address
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City I State r® Zip F_ Telephoned
CONTRACTOR'S NAME/COMPANY ��1 _-�`� r Lic. No. r� 1 / �l 11 Class SD
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Contractor's Address Contractor's E-mail Address
t'a C��50 C (.� 2(111
City State Zip cj TelephoneN jLI
SETBACKS REAR SETBACKS FRONT PERMIT NO. ✓ lK LO L 2_ -L3
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $ L -