HomeMy WebLinkAboutX2022-0944 - Permit Application,print Form '' Worksheet for Combo Building & Sola F7,Comm'I E, Residential City of Newport Beach - Building Di 'C�0"
`� 1
NOTE: PLAN CHECK FEES DUE AT TIME OF S BMITTAL
XBuilding ❑ Grading ❑'Drainage r Elec
Project Address (Not mailing addre;
Description of Work
®Mech TPlum cuvdcut
❑ Flood ❑ Fire ❑ Liq ❑ Landslide
New/Add SF Remodel SF ��
OWNER'S NAME Last
Cu Yd Fill
❑N/A Floor Suite No
�l F7 LJ
Use F-1 Const Type
# StoriesC # Units (if Res)
Valuation $ 1«'7
Garage/New/Add Material/Labor JDA &'.
First
Owner's Address Owner's E-mail Address/ q
5QD /fArcT�ov 15%qw+D r, �Gt/5!�ot?o % C�/Y/if/L . �e-k;k
City / C–juf%4 Fj�/ye/1 State �/-�- Zip Q7_/,�j Telephone �lffj�
APPLICANT'S NAME Last
Applicant's Address
5&aH*,L✓,
City State
First
Applicant's E-mail Address
Zip g� Telephone uo 0_C, Qi
ARCHITECT/DESIGNER'S NAME Last First —
Lic. No. F777-71
Architect/Designer's Address
City State
Architect/Designer's E-mail Address
Zip �J Telephoned
ENGINEER'S NAME Last 1 6yc- /Eii 71First 3� Lic. No. 09/3
Engineer's Address
(ia o. Sox11343
City CSQj� State 7d/4
Engineer's E-mail Address
5 N� Svc/yEiu a 5UE7yc"ti.�'�rvy
Zip R ttli, Telephone GDsn il. t7- 3 e/-7
CONTRACTOR'S NAME/COMPANY/A /rs J . No. �I ClassC
Contractor's Address �V L
50o fl ts� xiAwz> 2v
City J J State
SETBACKS REAR
SETBACKS LEFT
USE ZONE
SETBACKS FRONT
SETBACKS RIGHT
DEVELOPMENT NO
Contractor's E-mail Address
Zip F714/ Telephone g&,
PERMIT NO.
PLAN CHECK NO. 7Yj / / ,
PLAN CHECK FEES $