HomeMy WebLinkAboutX2022-0020 - Permit Application (2)Vie- 9 XU%� �
Print Form Worksheet for Combo Building & Solar Permit Applicatr��®R?r Comm'I j- Residential City of Newport Beach - Building DivisionNOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Auilding r- Grading rDrainage [Elec FMech F- Plum CuvdCut F Cu Yd Fill
Project Address (Not mailing address) F Flood F- Fire iq [_ Landslide [N/A Floor Suite No
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Description ofWork (SEE
Use F— Const Type
INTERIOR R -IiAl� (� }� a WINADWs '1 SL, pR
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# StoriesF_ # Units (if Res)r—
$
Valuation $
Material/LaborN)01000
New/Add SFr RemodelSF H Z? Garage/New/Add
OWNER'S NAME Lastpp, lf� First LL Is DW
Owner's Address Owner's E-mail Address
I oqI��� j- H 1101 5 LA:
City N�o�_.I,�-�i�l-� State _ Zip ,CC.. Telephone 1 _.8%'9'_t_�_%Z5
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APPLICANT'S NAME Last LiC7CTZ_ First pit)P-Eto
Applicant's Address Applicant's E-mail Address
2ASSL'Rar C6AST HwY # 23 G'0ETz_gRCH CflRY%ILIhIK N�7'.
City G iJ Y-� __- State K—i'C —, Zip u Gj ... Telephone f -6-73-31 r>?
ARCHITECT/DESIGNER'S NAME Last First Lic. No. r--
Architect/Designer's Address Architect/Designer's E-mail Address
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City -- State--- Zip-- Telephone
ENGINEER'S NAME Last 6�6eT7, First F_ Lic. Nof—
Engineer's Address Engineer's E-mail Address
City _ State I Zip �_— Telephone[—
elephonedCONTRACTOR'S
CONTRACTOR'SNAME/COMPANY —r S r) Lic. No f Class
Contractor's Address Contractor's E-mail Address
City _ '. State [_'. Zip [_. Telephoned
SETBACKS REAR SETBACKS FRONT PERMIT NO,
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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