HomeMy WebLinkAboutPV2022-022 - Permit Application.:Prin Form'' O Worksheet for Combo Building & Solar Permit Application
❑ Comm'I residential City of Newport Beach - Building Division PV2022-022
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
❑Building F_ Grading ❑Drainage ❑Elec ❑Mech F] Plum cu Ydcut�, Cu Yd Fill
1
Project Address (Not mailing address) ❑ Flood ❑ Fire ❑ Liq ❑ Landslide ❑N/A Floor Suite No
IS15 GnGI 1 � F-7
Description of Work
M a� e f comyi -
0,-2 Cc o,-2Cc
Use L7 Const Type
# Stories�i # Units (if Res)[7
—771 Valuation $f� 6l 7-1
New/Add SF Remodel SF Garage/New/Add Material/Labor'
OWNER'S NAME Last
C
First
Owner's AddressOwner's E-mail
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City State Cry Zip (cryo(
APPLICANT'S NAME Last
Applicant's Address
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City State ! w
First
ne+:
Applicant's E-mail AdKess
KL(oqI► - a 2k�J3
Zip 59�Telephond r6/ -a82• 511(3
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designer's Address
City �— State
Architect/Designer's E-mail Address
Zip F771 Telephoned
ENGINEER'S NAME Last _ First Lic. No.F 771
Engineer's Address
City State
Engineer's E-mail Address
Zip F____1 felephone��
CONTRACTOR'S NAME/COMPANY ;X Lic. No. Class (! Ccs
Contractor's Address
b/ W h✓fl rJ�
City e� J State C�
SETBACKS REAR
SETBACKS LEFT
USE ZONE
SETBACKS FRONT
SETBACKS RIGHT
DEVELOPMENT NO
Contractor's E-mail Address
I pct _ . C
Zip %3,�`jY Telephone t�j a8a gt
PLAN CHECK NO.
PLAN CHECK FEES $