HomeMy WebLinkAboutX2022-0515 - Permit ApplicationFrintForm A Worksheet for Combo Building & Solar Per i pli ti o4�`�Po"'e
17 Comm'I FX Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMI L .ow
+'
Building F-, Grading rDrainage iElec jTtlMech Plum CuvdCut CuYd
Juite
- -
Project Address (Not mailing address) ❑ Flood F Fire n Liq (- Landslide I /A Floor o
--- --------
Description of Work
Use FI Const Type n
# Stories 1 #Units (ifRes)F7
Valuation $
Material/Labor
I
New/Add SF Remodel SF d$_
Gara a/New/Add i
OWNER'S NAME Last NC�Ltuy� —i First
Owner's Address
Owner's E-mail Address
[__i -:�o-Z-P--------------- ----- - --
1
p---- - --- ---- _ -- --- -- - - ---- ---
City �Cil�o� State >� --_ Zip C�2(�(oC)--- Telephone7o -z53)3m(- Ale
APPLICANT'S NAME Last LoaJ
First 61 r� i
Applicant's Address
Applicant's E-mail Address
Z�2o SoS�iif� (31�t
City �� State
Zip �Z�o(x Telephone +l(ri49)F/(Z go
ARCHITECT/DESIGNER'S NAME Last
First r Lic. No.
Architect/Designer's Address
Architect/Designees E-mail Address
I
Ci
city - State
�
Zip - - -
i -
Telephoned
ENGINEER'S NAME Last_
First r Lic. No. F
Engineer's Address
Engineer's E-mail Address
i
city State �i
Zip I Telephone
CONTRACTOR'S NAME/COMPANY Lic. No. (p (o a9 ! Class
,� Cµs4v
Contractor's Address
Contractor's E-mail Address
_Z42o S_ N 6o( P__ ('CuQ_-
City Sa R - State (!}
Zip �2 �p t-( Telephone l(94 TJ 412- 4e 8a
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $