HomeMy WebLinkAboutX2022-0468 - Permit Application (2)X 2022. 0"A 09
Print Fgrm Worksheet for Combo Building & Solar Permit Application
Comm" j�Residential City of Newport Beach - Building Division
.11t, NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
TS7Building []Grading ❑Drainage ❑Elec ❑Mech ❑Plum CuvdCut � Cu Yd Fill
Address (Not mailing address) ❑ Flood ❑ Fire ❑ Liq ❑ Landslide ❑N/A Floor Suite No
Description of Work
S WAC- - Izz,
Useonst Type
# Stories # Units (if Res)[T
Valuation'
New/Add SF � Remodel SIF Garage/New/Add Material/Labor
OWNER'S NAME Last
First s Wk
Owner's Address Owner's E-mail Address
City ��_�� State Zip [ -------- 7 Telephoner
APPLICANT'S NAME Last
Applicant's Address
_ _?_Q Ilk
City State C.
First
Applicant's E-mail Address
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Zip Telephone
ARCHITECT/DESIGNER'S NAME Last �S� First
Architect/Designer's Address
City L State
Lic. No. G �
Architect/Designer's E-mail Address
Zip � Telephoned
ENGINEER'S NAME Last � First p �� Lic. No.
Engineer's Address Engineer's E-mail Address
city,..; �r-Cr State (� zip O '?i''J3 Telephone g g 5_bC)" 6� Z
CONTRACTOR'SNAME/COMPANY O G ! v t-r�� S Lic. No. 57 �� Class /J
Contractor's Address
city .�1N ,Z N(L%� Al �' �a State `/
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
Contractor's E-mail Address
Zip �'u�f' Telephone ?/ AoV_VS70
PERMIT NO. )Ol3
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $