HomeMy WebLinkAboutX2022-1275 - Permit Application�,, :Prot Form Worksheet for Combo Building & Solar Permit Application
F_ Comm'I i— Residential City of Newport Beach -Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITT u i
''Building F_ Grading rDrainage F_Elec F_Mech [` Plum Cu Yd Cut Cu Yd Fill
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Project Address (Not mailing address) F_ Flood r Fire r Liq r Landslide FN/A Floor
t(Q -7 SAS
Description of Work
Use Const Type F_,
# StoriesF—# Units (if Res)
Valuation $
Material/Labor
New/Add SF� Remodel SF�—
Garage/New/Add �—
OWNER'S NAME Last �� >"�
First
Owner's Address
Owner's E-mail Address
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APPLICANT'S NAME Last Mo ,Y)Ck
First
Applicant's Address
Applicant's E-mail Address
City State
Zip �— Telephoned
ARCHITECT/DESIGNER'S NAME Last
First F_ Lic. No.
Architect/Designer's Address
ArchitecUDesigner's E-mail Address
City State
Zip �— Telephoned
ENGINEER'S NAME Last
First Lic. No.[ --
Engineer's Address
Engineer's E-mail Address
City State
Zip Telephoner
CONTRACTOR'S NAME/COMPANY - Lic. No. of Class
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Contractor's Address
Contractor's E-mail Address
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city li�niin�}� l �✓C Ci) State
Zip q wi - Telephone (V)gO7- ,5 Z5
SETBACKS REAR SETBACKS FRONT
PERMIT NO. �C ) 2-iZ'7 S
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $