HomeMy WebLinkAboutX2022-0195 - Permit Application42012,-() lCi 5
Worksheet for Combo Building & Solar Permit Application
Comm'I Residential City of Newport Beach - Building Division
r NnTF• PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
[—,Building ( —Grading r'Drainage F—Elec F—Mech (—Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) F7 Flood r Fire r Liq 7 Landslide r7N/A Floor Suite Ni
s�o
Description of Work Use Const Type F
i ✓� I # Stories 2 # Units (if Res)r
F— Valuation CJ D
RemodelSF7— Garage/New/Add Material/Laa bor
New/AddSFI— c
OWNER'S NAMELast QoQ G1? i
First
Owner's Address Owner's E-mail Address
City State i %,(�_Zip O Telephone 9f,1, 9 bF
APPLICANTS NAME Last 4�M i-�t� T First rf!ry V S
Applicants Address Applicants E-mail Address
City Klrwzlcor i�4 t4i r _ _ State ZipTelephone T1J, I
ARCHITECT/DESIGNER'S NAME Last h First—G Lic. No. �—
Architect/Designer's Address Architect/Designer's E-mail Address
City State �— Zip �— Telephonel--
ENGINEER'S NAME Last First 70 t A ,\/ 67- Lic. No.Y3--9*9
Engineer's Address Engineer's E-mail Address
City S/� Zip
!Z/d p I)14 ISb��l0
State Zi Telephone V
CONTRACTOR'SNAMEICOMPANY ��(� Cd Lic. No. T�,-7G4D Classy
Contractor's Address Contractor's E-mail Address
Grz"N 4 u(v / 9City.(! , ,� State zip Cf '1 d� Telephone1-'64 J -1 1( C?
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
PERMIT NO. J1 "l LJ
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO _ — PLAN CHECK FEES $