HomeMy WebLinkAboutX2022-0029 - Permit Application:Print Form j Worksheet for Combo Building & Solar Permit rA\ lic`atic oc«W�,O
F- Comm'I r Residential City of Newport Beach - Building Division y2OT002 1
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL 4.oaN.
Building [Grading Drainage [Flet F_Mech (- Plum cuvdCut F CUVdFill
Project Address (Not mailing address) C Flood r Fire F-, Liq I— Landslide FN/A Floor Suite No
26o 1 W 61� Aly �-- ---
Description of Work
Use Const Type I
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4
#Stories # Units (if Res),
------ _.. --- -- — --
Valuation $
Material/Labor
New/Add SF " !;72 -- Remodel SFF— Garag a/New/Add �—
OWNER'S NAME Last 14dflt CC e C(, First `ice
Owner's Address `3 9 N� fl°� Owner's E-mail Address
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City f-OArP u7� State �i- Zip �1 ��5 Telephone
APPLICANT'S NAME Last 7a r�r F _ First /fie'
Applicant's Address Applicant's E-mail Address
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city ✓ G ° �� �c - StateR/� Zip 12ZG j " Telephone Syrr �� i fY�6
ARCHITECT/DESIGNER'S NAME Last �s,�f 9 / _
Architect/Designer's Address��i'�{' jv Architect/Designer's E- it Address
City State �— Zip F— Telephone
ENGINEER'S NAME Last, First Lic. No.
Engineer's Address Engineer's E-mail Address
City State F_ Zip I Telephone
CONTRACTOR'S NAME/COMPANY 3-/�4vK Lic. No.ClassG'
Contractor's Address Contractor's E-mail Address
.
City (�ilwt i /rfi CLJ _.....
State Zip `� 2� t _ Telephoned/f V 7-,6�
SETBACKS REAR SETBACKS FRONT PERMIT NO. V' "
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. c
USE ZONE DEVELOPMENT NO . f "�
' dL / PLAN CHECK FEES $