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HomeMy WebLinkAboutX2022-0644 - Permit Application (2)�Zo2 0Uyy. Worksheet for Combo Building & Solar Permit Application [, Comm'I �V, Residential City of Newport Beach - Building Division NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL jJ✓�uilding [Grading ( Drainage [;Flet F Mech F, Plum cuvdCut � cuvdFiu Project Address (Not mailing address) ❑ Flood ❑ Fire rj Liq❑Landslide ❑N/A Floor Suite No Description of Work l�e7q�hih� WOM, B)oa4 04 �ilar}ers i New/Add SF�I Remodel SF F �� Garage/New/Add Use F_111 Const Type 771 # StoriesF7 # Units (if Res) -1 Valuation $ Material/Labor OWNER'S NAME Last WOoc� ci$ First Qhd ---- - ---------- - ---- ---- Owner's Address Owner's E-mail Address - ----- --- N — - -@��n¢i1--------- ------ ------------ city /y Pa Csas F ---- State CA Zip q �J�7- ITelephone _jq . � 4a 2f APPLICANT'S NAME Last First Applicant's Address Applicant's E-mail Address x333 . -C. Cogs -1 i Y' -SK _Ne F §ZpAe . @ Rrt\bui143:S, caws City State �Zip/_6a,5 Telephone Tq,,gj- j! SF ARCHITECT/DESIGNER'S NAME Last First Lic. No. $f© Architect/Designer's Address ArchitecUDesigner's E-mail Address ---- - ------ ---------- ----- ---- - ' �%al¢w2.t,te�rn�t @ � wtat�. cot•, City ------- -- _— _ --- State �i Zip Telephone -1=F t w-/_ ENGINEER'S NAME Last — First Lic. No. R_/6 Engineer's Address Engineer's E-mail Address ---__----------. — ---------- ---_____ -_---_I . Va''12""'.t°4VWhi.° .dWIQ.`�.'Le"""1• ---- ----------i CityState �! Zip I Telephone CONTRACTOR'S NAME/COMPANY p e Lic. No. l 79 L _ I Class Contractor's Address Contractor's E-mail Address si�nn- ,__S4e _� City �fbv4- �!v`a — ----- State �'I Zip `��j � Telephone �x 52�.. �1 - SETBACKS REAR SETBACKS LEFT USE ZONE SETBACKS FRONT SETBACKS RIGHT DEVELOPMENT NO D Zo2'Z"OItZ PERMIT NO. %(ZOZZ -C)6gq PLAN CHECK NO. PLANCHECKFEES$)�+c%Z