HomeMy WebLinkAboutX2022-0021 - Permit Application (2)Z
Pint Form, W ksh t for Combo Building & Solar Permit Application
Form
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City of Newport Beach -Building m ig Division4, q .6
Xcom7l F Residential )<_ 'Ons-OW21
in 'I NOTE: PLAN CHECK FEES DUE AT TIME OF SUB AL
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F F g
Building F_ Grading rainage lec 7 Mach Plum Cu Yd Cut Cu Yd Fill
f _ I V �< F _. - I
Project Address (Not mailing address) F_ Flood f— Fire F -I Liq F_ Landslide ></A Floor Suite No
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Description of Work Use ConstType
Stories #Units (if Res)
F F
---------
Valuation L
New/Add SFF7777 Remodel SF Garage/New/AddF Material/Labor
abor
OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
City State Zip [TelephoneF
APPLICANT'S NAME Last
First �, I
Applicants Address Applicant's E-mail Address
cli_ q leTA
777
City c". 1�. State Zip Telephone 1
F777 F7777 - -__- -- -
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
F
Architect/Designer's k1ress Architect/Designees E-mail Address
City State F__ Zip F_ Teiephonel-,--,
ENGINEER'S NAME Last
Engineer's Address
City State
CONTRACTOR'S NAME/COMPANY
Contractor's Address
City StateF_
SETBACKSIREAR
SETBACKS FRONT
SETBACKSLEFT SETBACKS RIGHT
Lic. No. F Class F
Contractor's E-mail Address
Zip TelephoneF
PERMIT NO.
PLAN CHECK
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $ f CCU!, Q S