HomeMy WebLinkAboutX2022-0395 - Permit ApplicationPrint Form `'I Worksheet for Combo Building & Solar Permit AppMor Cit of New ort Beach - Buildin Division f)'A`
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
CiBuilding ❑Grading Drainage �� Elec F_ Mech F Plum Cu Yd Cut Cuvd Fill
Project Address (Not mailing address) F_' Flood F-, Fire F Liq F' Landslide ❑N/A Floor Suite No
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Description of Work
DFMO 54,-"D
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Use FI Const Type
# StoriesF_ # Units (if Res)F
� Valuation $ Q d1
New/Add SF RemodelSF�I Garage/New/AddI Material/Labor
OWNER'S NAME Last 13W�V,2
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Owner's Address Owner's E-mail Address
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APPLICANT'S NAME Last I %Zt S
First ti le -Loa,
Applicant's Address Applicant's E-mail Address
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City� A (V rJ er— State Zip Zb S/ Telephone 9q6 ' r -7y
ARCHITECT/DESIGNER'S NAME
Last e,JJA 11I i< Firstl �'c(A Lic. No.G 3s Z
Architect/Designer's Address Architect(Designees E-mail Address
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city ` /t%GS/J— - State Zip q26 Iii Telephone f 7S�f. �
ENGINEER'S NAME Last (� p FirstPl0 (JL Lic. No. i3sJ (q
Engineer's Address Engineer's E-mail Address
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CONTRACTOR'S NAME/COMPANY 6ALlA___gVlt.dVstitr !NG Lic. No. qT2-2-I Ill Class;
Contractor's Address
Contractor's E-mail Address
1278 45;t.ejr�4�/1d
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city
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State
Zip
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Telephone C!c%� 7V
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SETBACKS REAR
SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.
USE ZONEy
DEVELOPMENT NO'�I7 L�U`�
PLAN CHECK FEES $