HomeMy WebLinkAboutX2022-0088 - Permit ApplicationPrint Form 11
F Comm'I
Worksheet for Combo Building & Solar Permit Application
Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F_ Building r Grading
F-Drainage �lec, 5,kech F- Plum cuydcutF_ CuYdFill F_
Project Address (Not mailing address) F_ Flood r Fire F_ Liq F_ Landslide rN/A Floor Suite No
Description of Work
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Use F— ConstType
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# Stories_ # Units (if Res)[-
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Valuation V
Material/Labor T
New/Add SF
Remodel SF F_ Garage/New/Add
OWNER'S NAME
M�—
Last `�A First t�1� Li
Owner's Address
Owner's E-mail Address
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City
State F Zip F_ Telephone q'}q �10l.L4
APPLICANT'S NAME
Last First
Applicant's Address
Applicant's E-mail Address
City
State Zip Telephoned
ARCHITECT/DESIGNER'S NAME Last 'RplQy� First Lic. No.
Architect/Designer's Address
ULC , Architect/Designer's E-mail Address
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City c vy [lkf4 State Zip Telephone 1iT - I1 .1$6g
ENGINEER'S NAME
Last First Lic. No.F—
Engineer's Address
Engineer's E-mail Address
City
State � Zip F_ Telephoned
CONTRACTOR'S NAME/COMPANY Lic. No. Class
Contractor's Address
Contractor's E-mail Address
City
State �— Zip Telephoned
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SETBACKS REAR
SETBACKS FRONT PERMIT NO. Q0cll7 -U"—
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. ` U.ttsqL'Jd'1lY
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