HomeMy WebLinkAboutX2022-0220 - Permit Application (2)Pant Form ! Worksheet for Combo Building & Solar Permit Application ooI
F-1Comm'I Residential City of Newport Beach - Building Division XWZ-0220
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL C4 apY
15tBuilding ❑Grading FjDrainage ❑Elec [Mech ❑Plum cu ydcutr___7 Cu yd Fin!
Project Address (Not mailing address) ❑Flood r Fire F_ Liq rI Landslide ❑N/A Floor Suite No
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D(�escription of Work 1 \,1 z
New/Add SFRemodel SF� l Garage/New/Add [7---7-
OWNER'S NAME Last'e� l ptn✓hunl �7� First
Owner's Address Owner's E-mail Address
Use n Const Type n
# Storiesn # Units (if Res)7
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City�jCAG h State ZipFAT( Telephone IZca
APPLICANTS NAME Last
Applicant's Address
Lt -4 GSIa
City `( Vyyi Z, State
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First
Applicant's E-mail Address
f11GrC`nSae z-G�rc. &Jyvl
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Zip ��i018 Telephone l—q i—oz -97Go
ARCHITECT/DESIGNER'S NAME �
Last First F _7 Lic. No. L
Architect/Designer's Address
I
City State
ENGINEER'S NAME
Architect/Designer's E-mail Address
Zip F7 Telephone j
Last First (;( J Lic. No.
Engineer's E-mail Address
cy ' 4 -on& u e'o com
Zip 4Mg D
Telephone[1741 Q$Q-(oS)
Engineer's Address
city h v /I7Gc_9�w -- State
CONTRACTOR'S NAME/COMPANY
Contractor's Address
City l�U1n� State
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
Lic. No. gj�i `j�j fes, Classl
Contractors E-mail Address
Zip ��(. - Telephone qLIq-4v2 --�b
PERMIT NO.
PLAN CHECK NO.
USE ZONE DFVqLOPMENT NO�!"# L -U 4i1 PLAN CHECK FEES $