HomeMy WebLinkAboutX2022-0951 - Permit Application�24t-- #%j
Worksheet for Combo Building & Solar Permit Application
r Comm'I F- Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
('Building F- Grading ("Drainage j- Elec
ect Address
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F- Mech F- Plum
Cu Yd Fill
(- Flood F_ Fire F Liq F- Landslide F -N/A Floor Suite No
New/AddSFF— Remodel SF F_ Garage/New/Add F_
Use P7� Const Type
# Stories # Units (if Res)i
Valuation$ { (y-��
Material/Labor 1 Do
OWNER'S NAME Last ' _ v (p/ -
First i Z s t7v
Owner's Address
Owner's E-mail Address
Owners
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City State F,Zip
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APPLICANT'S NAME Last FS i r \ 4 First �;
Applicant's Address
Applicants E-mail Address
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City C State
Zip%� Telephone
ARCHITECT/DESIGNER'S NAME Last
First F_ Lic. No. F—
ArchitecUDesigner's Address
Architect/Designer's E-mail Address
City State --
Zip �— Telephoner —
ENGINEER'S NAME Last y� R b First i /? I � Lic. No.�� %
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Engineer's Address
Engineer's E�--Imail Address
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cityZState �v�(Zip
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CONTRACTOR'SNAMECOMPANY Lic. No.G-3-7440✓i
Contractor's Address
Contractor's E-mail Address
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City 1 State ' j1
Zip14� -2:10!) Telephone, 71 5}/
NO. 4W^ Z�p✓rO�
SETBACKS REAR SETBACKS FRONT
PERMIT
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. 08 1 �70ZY
USE ZONE DEVELOPMENT NO
- /-- PLAN CHECK FEES $