HomeMy WebLinkAboutX2022-0563 - Permit ApplicationPririt Form Worksheet for Combo Building & Solar Pe�;21 okf ✓6
r Comm'I n Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding r Grading rDrainage r, Elec n Mech rl Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) ❑ r r'g r-N/A�I
Flood i Fire Li Landslide r Floor Suite No
Description of Work Use Const Type
1' I RIA j # Stories # Units (if Res) '
New/Add SF F777--', Remodel SF �—", Garage/New/Add
OWNER'S NAME Last
First
valuation $
Material/Labor 3gK-
Owner's Address Owner's E-mail Address
City ! State F - _1 Zip �II Telephoned
APPLICANTS NAME Last
Applicant's Address
City State F 7,I
First
Applicant's E-mail Address
ZipTelephoned
�I
ARCHITECT/DESIGNER'S NAME Last �— First
Architect/Designees Address
City State
F777
ENGINEER'S NAME
Lic. No. F77777
Architect/Designer's E-mail Address
Zip s Telephoned—
Last �— - First
Engineer's E-mail Address
Zip Telephone
F_
Address
City State—j
CONTRACTOR'S NAME/COMPANY
Lic. No.F—',
tl� T bey _G(fhSbKIi vy1' Lic. No. 062� 1 3
Class �
Contractor's Address
of
M_�rroi
City vw� e Yvm0. Vii, State
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
Contractor's E-mail Address
zip
j— TelephJone `
a�vb Cq'li)'�3y X33 f
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEES S